Acute ischemic stroke and transient ischemic attack

Stroke refers to the clinical syndrome of sudden onset of focal or global disturbance of central nervous system function, with no apparent cause other than a vascular cause. Ischemic stroke is responsible for about 80% of all strokes, intracerebral hemorrhage (ICH) for 15%, and subarachnoid hemorrhage (SAH) for 5%. A transient ischemic attack (TIA) has the same symptom complex as a stroke, but with a resolution of these symptoms within 24 hours. Most TIAs though resolve within 1 hour, it is increasingly understood that TIAs and minor strokes represent a continuum of disease. Some suggest that the time-based definition of TIA yield to a tissue-based definition, as approximately one-third of people with clinically diagnosed TIAs will actually have structural changes visible on neuroimaging, such as diffusion-weighted MRI scanning. This chapter discusses about acute ischemic stroke and transient ischemic attack, the mechanism of pathophysiology, epidemiology, thrombolysis and clot retrieval, organization of care, treatment of acute ischemic stroke using antiplatelet agents, anticoagulants, HMG CoA reductase inhibitors, cooling, and neuroprotective agents; management of complications by controlling for blood pressure and blood glucose; and treating brain edema with mannitol, glycerol, corticosteroids, and craniectomy. In summary, TIA is a neurological emergency, and as such mandates prompt evaluation with the goal to identify the etiologic cause of the event and implement early therapy to prevent TIA recurrence, stroke, cardiovascular events, and death.