Analytic Review: Ischemic Cerebrovascular Disease: Diagnosis and Management

Abstract

Ischemic stroke is the most common cause of neurologic morbidity and mortality. The proper management of a stroke patient is dictated by the underlying pathophysiology. An ischemic stroke may occur as a result of restricted flow or thrombosis from atherosclerosis, artery-to-artery embolization, cardiac-to-brain embolization, or disorders of coagulation, to mention a few of the most common causes. Determining the relevant cause of stroke is made more difficult by the coexistence of many possible factors such as hypertension, atherosclerosis, and cardiac disease. Nevertheless, judgments are based on the clinical presentation, computed tomographic scans, cerebral angiograms, and results of echocardiography and electrocardiographic monitoring. Therapy of the ischemic stroke patient is aimed primarily at preserving areas of potentially recoverable ischemic brain. This is accomplished by correcting or avoiding circumstances that can promote further impairment of ischemic brain. These include proper management of blood pressure, cardiac function, oxygenation, and fluid balance. The role of anticoagulation, hemodilution therapy, and other proposed forms of therapy is often unclear.