Acute stroke in ICU: ischaemic, haemorrhagic, and neurocritical care

Also known as Ischaemic stroke · Haemorrhagic stroke · Intracerebral haemorrhage · Thrombolysis · Thrombectomy · Stroke ICU management

Acute stroke ICU management. ISCHAEMIC (80%): thrombolysis (alteplase within 4.5h — NINDS, ECASS III), thrombectomy (within 6-24h for large vessel occlusion — DAWN, DEFUSE-3), antiplatelet (aspirin within 24h), prevent complications. HAEMORRHAGIC (20%): blood pressure control (SBP <140 — INTERACT2), reverse coagulopathy, surgery (evacuation for cerebellar 3cm or lobar with deterioration), ICP management. ICU principles: definitive airway control when consciousness and reflexes fail, supplemental oxygen for saturation below 94%, normocapnia, normoglycaemia (140–180 mg/dL range, avoiding hypoglycaemia), normothermia, blood pressure management (permissive hypertension for ischaemic, controlled for haemorrhagic), DVT prophylaxis, swallowing assessment before oral intake.

high38 referencesUpdated 26 July 202629 min readSource-verified · Oct 2026

Checked against its sources on 1 Oct 2026

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8 MCQs

Meet the patient

A 64-year-old man is brought to the emergency department at 7am, fifty minutes after his wife found him slumped in bed, unable to lift his right arm and speaking only jargon. Blood pressure 196/104, glucose 8.2 mmol/L, NIHSS 16, GCS 14. The CT scanner is warming before the cannula is in. The clock that matters now is the door-to-needle clock.^[1]

Two questions decide his next hour, and they decide every acute stroke: is the CT bright or dark? (ischaemic versus haemorrhagic — the fork that reverses every target), and can I reperfuse in time? (the clock from onset to needle or groin puncture). Hold those two questions and the whole ICU plan slots into place behind them.^[1]

References38Show

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