ABSTRACT
Intravenous thrombolytic therapy should be considered for patients with ischemic stroke, those for whom the duration of symptoms is ≤3 hours, and those with no contraindications. Angiographic intraarterial thrombolytic therapy appears to be beneficial if given within 6 hours, particularly with documented occlusion of middle cerebral or basilar artery. Clinical deterioration after thrombolysis should be presumed to represent intracerebral bleeding until proven otherwise—stop tPA infusion immediately (and heparin, if used), and obtain a noncontrast CT scan of the head immediately. Neurosurgical decompression may be indicated for large cerebellar or intracerebral hemorrhage, especially if there is associated hydrocephalus or a deteriorating level of consciousness. Ventriculostomy is indicated for basal ganglia hemorrhage associated with hydrocephalus. Maintaining normothermia with antipyretics or cooling blankets may improve outcome after stroke.
