Ischemic stroke

Descripción general 
Teoría 
Diagnóstico 
Manejo 
Seguimiento 
Recursos 

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Evidencia revisada por última vez: 15 Aug 2026

Tema actualizado por última vez: 05 Jun 2026

Ischemic stroke is caused by a transient or permanent critical reduction in cerebral blood flow due to arterial stenosis or occlusion. It is a leading cause of morbidity and mortality worldwide.

Stroke is a clinical emergency: timely diagnosis, triage, and intervention improves outcomes.

Care of patients in dedicated stroke units improves survival and function.

Intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA) is most effective when given within 4.5 hours of stroke onset, and remains the standard of care. In patients with unknown time of onset or who present beyond 4.5 hours, imaging can be used to detect those with salvageable ischemic penumbra and who may benefit from intravenous thrombolysis.

Intravenous thrombolysis plus mechanical thrombectomy to treat large vessel occlusive (LVO) stroke within 6 hours of stroke onset is effective. Thrombectomy to treat LVO stroke is effective within 24 hours of onset if a penumbra is identified by multimodality imaging studies. Thrombectomy may improve functional outcome in LVO patients with a large core infarction or poor collateral circulation within 24 hours of onset.

Definición

Stroke is defined as an acute neurologic deficit caused by cerebrovascular abnormality. It is further subdivided into ischemic stroke (caused by arterial occlusion or stenosis) and hemorrhagic stroke (caused by vascular rupture, resulting in intraparenchymal and/or subarachnoid hemorrhage).

This topic deals with ischemic stroke.

Transient ischemic attack (TIA) is defined as a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction. Patients with TIAs are at high risk for early ischemic stroke.[1] See Transient ischemic attack.

Anamnesis y examen

Principales factores de diagnóstico

vision loss or visual field deficit
weakness
aphasia
ataxia (impaired coordination)

Todos los datos

Otros factores de diagnóstico

history of transient ischemic attack (TIA)
sudden onset of symptoms
negative symptoms (i.e., loss of function)
altered sensation
headache
diplopia
sensory loss
dysarthria
"crossed" syndromes
gaze paresis
arrhythmias, murmurs, or pulmonary edema
vertigo/dizziness
nausea and/or vomiting
neck or facial pain
miosis, ptosis, and facial anhidrosis (hemilateral)
altered level of consciousness/coma
confusion

Todos los datos

Factores de riesgo

hypertension
older age
sickle cell disease
family history of stroke
history of transient ischemic attack (TIA)
history of ischemic stroke
cerebral microbleeds
smoking
diabetes mellitus
atrial fibrillation
comorbid cardiac conditions
carotid artery stenosis
intracranial atherosclerosis (ICAS)
dyslipidemia
lower levels of education
cancer
ethnicity
poor diet and nutrition
low birth weight
physical inactivity
obesity
alcohol misuse
use of oral estrogen-containing therapy
pregnancy
migraine
severe obstructive sleep apnea
long sleep duration and poor sleep quality
illicit drug use
hyperhomocysteinemia
elevated lipoprotein(a)
hypercoagulable states
elevated C-reactive protein
aortic arch plaques
patent foramen ovale (PFO)
air pollution
e-cigarettes
infections
endometriosis

Todos los datos

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

blood glucose
CT head
MRI brain
CT angiography or magnetic resonance angiography
CT or MRI perfusion
serum electrolytes
serum BUN and creatinine
cardiac enzymes
ECG
CBC
coagulopathy screen

Todos los datos

Pruebas diagnósticas que deben considerarse

serum toxicology screen
infection screen
genetic testing
CXR
carotid ultrasound
echocardiogram
transcranial Doppler ultrasound
conventional (invasive) angiography

Todos los datos

Algoritmo de tratamiento

Inicial

suspected acute ischemic stroke

Agudo

acute ischemic stroke

Colaboradores

Consejeros especializados

David Wang, DO, FAHA, FAAN

Director, Vascular Neurology and Stroke

Director, Neurology Residency Program

Professor of Neurology

HonorHealth/ASU John Shufeldt School of Medicine and Medical Engineering

Scottsdale, AZ

Divulgaciones

DW received honorarium from Boehringer Ingelheim for lectures on the use of thrombolytics for acute ischemic stroke. He has also received honorarium from Amgen, Zhongmei Huadong, and ShiYao Pharmaceuticals for speaking. DW was Chair, Stroke Section of the American Academy of Neurology, 2017-2019. He was Chair, Quality and Safety Subcommittee of the American Academy of Neurology (term ended June 2018). DW is Deputy & Managing Editor, Stroke and Vascular Neurology. DW is an author of references cited in this topic.

Yi Dong, MD, PhD

Department of Neurology

Huashan Hospital

Fudan University

Shanghai

China

Divulgaciones

YD declares that she has no competing interests.

Yilong Wang, MD, PhD

Professor of Neurology

Deputy Director, Department of Neurology

Beijing Tiantan Hospital, Capital Medical University

Beijing

China

Divulgaciones

YW declares that he has no competing interests.

Agradecimientos

Dr David Wang, Dr Yi Dong, and Dr Yilong Wang would like to gratefully acknowledge Dr George Ntaios and Dr Alireza Minagar, the previous contributors to this topic.

Divulgaciones

GN is on the advisory boards for, and has received honoraria, speaker fees, and research support from: Amgen, Bayer, Boehringer-Ingelheim, BMS/Pfizer, Elpen, Galenica, Medtronic, Sanofi, and Winmedica. AM declares that he has no competing interests.

Revisores por pares

Nishant K. Mishra, MD, PhD, FRCP, FAHA

Assistant Professor of Neurology

Yale University

New Haven, CT

Divulgaciones

NM declares that he has no competing interests.

Julien Morier, MD

Neurology Registrar

Neurology Service

Centre Hospitalier Universitaire Vaudois (CHUV)

Lausanne

Switzerland

Divulgaciones

JM declares that he has no competing interests.

Louis R. Caplan, MD

Lecturer in Neurology

Hospital Chief

Cerebrovascular/Stroke Division

Beth Israel Deaconess Medical Center

Division of Cerebrovascular/Stroke

Boston, MA

Divulgaciones

LRC declares that he has no competing interests.

Tony Rudd, MD

National Clinical Director

Stroke NHS England

Professor, Stroke Medicine

Kings College London

Chair, Intercollegiate Stroke Working Party

Royal College of Physicians

London

Divulgaciones

TR declares that he has no competing interests.

Agradecimiento de los revisores por pares

Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.

Divulgaciones

Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-467.Texto completo Resumen

Prabhakaran S, Gonzalez NR, Zachrison KS, et al. 2026 guideline for the early management of patients with acute ischemic stroke: a guideline from the American Heart Association/American Stroke Association. Stroke. 2026 Jan 26 [Epub ahead of print].Texto completo Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Cerebral venous sinus thrombosis
- Intracerebral hemorrhage
- Transient ischemic attack (TIA)
Más Diferenciales
Guías de práctica clínica
- 2026 guideline for the early management of patients with acute ischemic stroke
- Canadian stroke best practice recommendations: acute stroke management, 7th edition
Más Guías de práctica clínica
Calculadoras
ASCVD Risk Estimator
Atrial Fibrillation CHA(2)DS(2)-VASc Score for Stroke Risk
Más Calculadoras
Videos
Tracheal intubation: animated demonstration
Bag-valve-mask ventilation: animated demonstration
Más vídeos
Folletos para el paciente
Stroke: treatment
Stroke: preventing another stroke
Más Folletos para el paciente
Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

El uso de este contenido está sujeto a nuestra cláusula de exención de responsabilidad

Ischemic stroke

Resumen

Definición

Anamnesis y examen

Principales factores de diagnóstico

Otros factores de diagnóstico

Factores de riesgo

Pruebas diagnósticas

Primeras pruebas diagnósticas para solicitar

Pruebas diagnósticas que deben considerarse

Algoritmo de tratamiento

suspected acute ischemic stroke

acute ischemic stroke

Colaboradores

Consejeros especializados

David Wang, DO, FAHA, FAAN

Divulgaciones

Yi Dong, MD, PhD

Divulgaciones

Yilong Wang, MD, PhD

Divulgaciones

Agradecimientos

Divulgaciones

Revisores por pares

Nishant K. Mishra, MD, PhD, FRCP, FAHA

Divulgaciones

Julien Morier, MD

Divulgaciones

Louis R. Caplan, MD

Divulgaciones

Tony Rudd, MD

Divulgaciones

Agradecimiento de los revisores por pares

Divulgaciones

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guías de práctica clínica

Calculadoras

Videos

Folletos para el paciente

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión o suscríbase para acceder a todo el BMJ Best Practice

Inicie sesión para acceder a todo el BMJ Best Practice