Acute Stroke

Koto Ishida, MD

Navdeep Sangha, MD

The intent of this issue of Seminars in Neurology is to provide insight into topics related to stroke that extend “beyond the guidelines.” The field of vascular neurology has undergone a remarkable evolution over the last several years, particularly regarding care in the acute and hyperacute stages given the advancement of endovascular therapies. This paradigm shift was reflected in rapid updates to existing guidelines. Despite this progress, there are still numerous unanswered questions about the optimal management of these (and other) patients where reliable data are lacking, and guidelines fall silent. We dedicated this review to focus on these highly relevant but underrepresented clinical topics.

The included articles encompass the continuum of stroke management, ranging from prehospital care and hyperacute stroke therapies to poststroke recovery and complications. Many of the reviews feature newer care models, experimental therapeutics, or patient subgroups that are not well represented in current practice recommendations. Although high-level evidence is limited, these reviews provide updated, comprehensive overviews of the supportive literature regarding these topics as an adjunct to existing guidelines, keeping the general neurologist in mind.

As the treatment window continues to expand and patient selection criteria become less selective, the number of acute stroke patients who are eligible for these therapies has increased substantially. As a result, stroke care has become much more nuanced. However, vascular neurology is still a relatively nascent field, and research continues to advance our knowledge within these more uncertain areas. Each of these articles will provide an overview of the current state of the evidence, as well as identify future trends and upcoming studies that may provide further insight into these topics.

We hope that you find these reviews stimulating and informative, and that they offer a practical clinical construct for providing individualized care of patients across the spectrum of stroke.

Publication History

Article published online:
22 February 2021