Acute stroke complications represent a spectrum of life-threatening neurological and systemic issues that frequently require admission to a specialized neurocritical care unit within the ICU. Stroke, whether ischemic or hemorrhagic, can rapidly lead to cerebral edema, raised intracranial pressure, airway compromise, aspiration, seizures, and secondary organ dysfunction. The period following an acute stroke is particularly high risk, and intensive monitoring is essential to prevent irreversible brain injury and improve functional outcomes.

Patients may present with altered consciousness, severe weakness, speech impairment, abnormal breathing patterns, or hemodynamic instability. Large territory strokes and intracerebral hemorrhages are especially prone to complications such as brain swelling, hydrocephalus, and herniation. In addition, stroke patients are vulnerable to respiratory infections, cardiac arrhythmias, and metabolic disturbances that further complicate recovery.

ICU management focuses on preserving cerebral perfusion and preventing secondary brain injury. Careful control of blood pressure, oxygenation, blood glucose, and body temperature is critical, as fluctuations can worsen neurological damage. Continuous neurological assessment allows early detection of deterioration and timely intervention.

Airway protection and mechanical ventilation may be required in patients with reduced consciousness or impaired swallowing. Intracranial pressure monitoring and neuroimaging guide treatment decisions in severe cases. Seizure management, prevention of aspiration, and early treatment of infections are integral parts of ICU care.

Stroke patients often require coordinated care involving intensivists, neurologists, neurosurgeons, and rehabilitation specialists. Early ICU intervention significantly reduces mortality and improves neurological recovery, particularly in patients with severe or complicated strokes.