THE MANAGEMENT OF STROKE IN THE EMERGENCY DEPARTMENT

Abstract

This study reviews the current management of stroke, highlighting the importance of rapid intervention to minimize irreversible neurological damage. The diagnostic approach begins with a thorough neurological evaluation, followed by a computed tomography (CT) scan of the skull to differentiate between ischemic and hemorrhagic stroke. CT is crucial for guiding therapeutic strategies and ruling out other conditions with similar symptoms. In ischemic stroke, the focus is on restoring cerebral blood flow. Intravenous thrombolysis with alteplase, within the ideal therapeutic window (usually up to 4.5 hours from the onset of symptoms), is the main intervention, aimed at dissolving the clot obstructing the blood vessel. However, strict inclusion and exclusion criteria must be followed to minimize risks. For selected cases, mechanical thrombectomy, which physically removes the clot, offers an alternative or complement to thrombolysis, especially in large vessel occlusions. The management of hemorrhagic stroke focuses on controlling blood pressure to prevent the expansion of the intracranial hematoma. Antihypertensive drugs are administered cautiously to avoid hypotension. In selected cases, surgery (craniotomy) may be necessary to evacuate the hematoma or repair the ruptured vessel. Regardless of the type of stroke, life support is essential, including cardiac and respiratory monitoring, glycemic control and prevention of complications such as deep vein thrombosis and pressure ulcers. After the acute phase, multidisciplinary rehabilitation, including physiotherapy, occupational therapy and speech therapy, is essential for functional recovery and improving quality of life. Early and intensive rehabilitation shows positive results in neurological recovery and in patients' functional independence. The article emphasizes the need for standardized clinical protocols, adequate training of medical staff and rapid access to diagnostic and therapeutic resources to optimize stroke management and improve prognosis.