Severe ischemic stroke is characterized by severe neurological deficits, sometimes accompanied by cardiovascular and respiratory dysfunction, which could lead to severe disability and death. This article reviews the national and international trials of reperfusion treatment for severe ischemic stroke in recent 20 years, and summarizes relevant clinical guidelines and expert consensuses. In general, intravenous thrombolysis is not restricted for patients with severe neurological deficits, but should be cautiously considered for patients with large infarction. Patients with large vessel occlusion could benefit from endovascular treatment, and whilst prevention and treatment for brain edema are important for patients with very large infarction. For patients who have received reperfusion therapies, the target for the management of blood pressure should incorporate the status of recanalization and a stable level of blood pressure should be maintained.
Objective To explore the clinical and imaging features of patients with acute dizziness and assess their associations with 3-month prognosis. Methods We enrolled adult patients with a chief complaint of acute dizziness, who were admitted to the Neurological Clinic at the Emergency Department of West China Hospital, Sichuan University between January 1st and May 31st 2022. We collected clinical and imaging features at baseline for each patient. The primary outcome was recurrent dizziness within 3 months after index dizziness. Secondary outcome was stroke within 3 months after index dizziness. Results A total of 1 322 patients who visited the Neurological Clinic were included, of which 617 (46.7%) had a chief complaint of acute dizziness. Among 222 patients who performed emergent brain and neck CT angiography, 1 patient presented with intracerebral haemorrhage. Among the remaining 221 patients, 206 patients completed 3-month follow-up, with 76 patients reported recurrent dizziness and 7 patients had stroke (6 ischaemic, 1 hemorrhagic). The multivariate logistic regression showed that chronic dizziness duration and parenchymal hypodensity on brain CT were each associated with a higher risk of recurrent dizziness. Compared with those who did not report stroke, the stroke patients were more likely to present with hypertension, headache symptoms, and exhibit parenchymal hypodensity on baseline CT (P<0.05). Conclusions In patients with acute dizziness, those with chronic dizziness duration and parenchymal hypodensity on baseline CT were associated with a higher risk of 3-month recurrent dizziness. Acute dizziness patients experiencing 3-month stroke often have hypertension, headache symptoms, and parenchymal hypodensity on baseline CT.