The Management of Acute Cerebral Infarction

There is no evidence that we are able to reverse cerebral infarction once it gets underway. The day may come when some form of protection for neuronal activity is available to us, but at present there is no such treatment. Prevention is the most important concept; prevention of transient ischemic attack (TIA) or prevention of progression once the process has started. Progressing stroke is that all too common circumstance where focal ischemia is worsening and the process of infarction is beginning or extending. The patient may be seen in the office, emergency room, or in the hospital, and the patient’s classification may be changed on successive examinations. There is nothing unusual about such reclassification. For instance, a patient may be admitted to an intensive cardiac care unit with a tentative diagnosis of myocardial infarction; the diagnosis will be changed if the findings change. Thus we look at a patient entering the hospital with a modest neurological defect in the right arm and reexamine the individual some time later. If the defect is worse, we say that the stroke is progressing; if the patient is the same, it appears that the process is completed; if the defect has disappeared, the diagnosis may be TIA