AIS Slideset 2013 with copyright and new slide解析.ppt

XVI. Treatment of Acute Neurological Complications Given the complexity of severe stroke and potential complications, multidisciplinary care teams comprised of neurologists, neurointensivists, and neurosurgeons, as well as dedicated stroke nursing, are required to optimally manage these complex patients. * Copyright ? 2013 American Heart Association XVI. Treatment of Acute Neurological Complications Class I Recommendations Class, Level of Evidence (LOE) Patients with major infarctions are at high risk for complicating brain edema and increased intracranial pressure. Measures to lessen the risk of edema and close monitoring of the patient for signs of neurological worsening during the first days after stroke are recommended. Early transfer of patients at risk for malignant brain edema to an institution with neurosurgical expertise should be considered. (Revised from the previous guideline) Class I, LOE A Decompressive surgical evacuation of a space occupying cerebellar infarction is effective in preventing and treating herniation and brain stem compression. (Revised from the previous guideline) Class I, LOE B Decompressive surgery for malignant edema of the cerebral hemisphere is effective and potentially life-saving. Advanced patient age and patient/family valuations of achievable outcome states may affect decisions regarding surgery. (Revised from the previous guideline) Class I, LOE B Recurrent seizures after stroke should be treated in a manner similar to other acute neurological conditions and anti-epileptic agents selected by specific patient characteristics. (Unchanged from the previous guideline) Class I, LOE B Placement of a ventricular drain is useful in patients with acute hydrocephalus secondary to ischemic stroke. (Revised from the previous guideline) Class I, LOE C * Copyright ? 2013 American Heart Association XVI. Treatment of Acute Neurological Complications Class II Recommendation Class, Level of Evidence (LOE) Although aggressive medical measur