åêðáéäåõóçó γ.ν.α.

371
Οξύ αγγειακό εγκεφαλικό επεισόδιο
Α Ταβερναράκης
SUMMARY
Tavernarakis A. Acute cerebral episode. The main purpose of the management of the cerebrovascular
attacks in the acute phase in the emergency unit is to support the diagnosis, approach the
mechanism and the cause of the attack (on which depend the prognosis and the therapy), to predict
and face efficiently the immediate complications, either general or neurological that may affect the
overall prognosis, concerning the patient’s life or the neurological deficits, and finally, begin as soon
as possible the appropriate treatment. The presence of specific units with specialized staff for the
management of strokes (stroke units) is considered very helpful. During the last years, the improvement
of the overall prognosis is due to the better management in these units of the immediate
complications, caused by all the conditions that aggravate the ischemic lesions (disturbances in blood
oxygen concentration, infections, hypotension, heart dysfunction, volume or electrolyte imbalance).
Moreover, the more and more frequent use of intravenous thrombolysis, even if it concerns a small
proportion of patients (because of the time limit of 3 hours from the onset of the symptoms), is a
useful tool at our disposition. The correct management of neurological complications, like cerebral
oedema, haemorrhagic conversion or epileptic seizures is of major importance. Intubation should
be performed in relatively young patients after an overall evaluation of the patient’s general prognosis.
The surgical management in the acute phase concerns very specific cases (extensive infarcts of
the middle cerebral artery, cerebellar infarct or cerebral lobar hematoma in patients > 60-65 years
old). Antiplatelet or anticoagulation therapy doesn’t have, for the time being, other indications than
prevention of the early relapses, when there are no contraindications. The cerebrovascular episode
is an extremely emergent medical condition, and the health system should adapt itself, so to offer
these patients the best chances of survival and recovery. Nosokomiaka Chronika, 71, Supplement,
371-383, 2009.
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Key words: acute ischemic attack, acute cerebrovascular episode, stroke.
ΠΕΡΙΛΗΨΗ
Βασικός σκοπός της αντιμετώπισης των Αγγειακών Εγκεφαλικών Επεισοδίων (ΑΕΕ), στην
οξεία φάση στην Μονάδα Επειγόντων Περιστατικών είναι να επιβεβαιώσουμε την διάγνωση,
προσδιορίσουμε τον μηχανισμό και την αίτια (από τούς οποίους εξαρτάται η πρόγνωση και η
θεραπεία), να προβλέψουμε και να αντιμετωπίσουμε αποτελεσματικά τις άμεσες επιπλοκές,
γενικές η νευρολογικές οι οποίες μπορούν να υπονομεύσουν την γενική πρόγνωση τόσο όσον
αφορά την ζωή όσο και τις υπολειμματικές βλάβες και τέλος να αρχίσουμε το δυνατόν συ-
Αν. Διευθυντής, Νευρολογικό Τμήμα, Γ.Ν.Α. “O Ευαγγελισμός”