Management issues for patients with ischemic stroke.

This review briefly summarizes the acute management of cerebral infarction and cardiac comorbidity in patients with stroke, with a focus on more general aspects of care. Important aspects of the acute management of cerebral infarction are its prompt recognition, use of appropriate emergency medical services, including 911, initial treatment, and prevention of complications. Secondary prevention begins with the diagnostic workup for the cause of the initial stroke. Although the optimal workup depends on the patient, a minimal workup consists of a history and physical examination sufficient to establish vascular risk factors and the neurologic and medical status of the patient, basic laboratory tests, ECG, chest x-ray, cranial CT, evaluation of carotid arteries, and a search for cardiac sources and the presence of atrial fibrillation. Further workup may include a search for coagulopathies, less common sources of embolism, and intracranial intravascular disease. Better education of patients at risk of vital importance. Patients with cerebral infarction share vascular risk factors with those who have coronary disease, and the presence of both coronary and cerebrovascular disease is highly likely. The likelihood of finding coronary artery disease in patients with transient ischemic attack and ischemic stroke with noninvasive testing, as well as management recommendations for these patients are reviewed.