Diagnosis and therapeutic aspects of stroke.
Detailed assessment of stroke is essential to distinguish haemorrhage from infarction, to establish the vascular territory affected and to identify patients with carotid stenosis or cardio-embolic disease. Computed tomography scanning should be routinely undertaken. Duplex Doppler sonography and echocardiography should be readily available but used selectively. Hypertension should not be treated early after ischaemic stroke. Issues requiring research include the optimal time to institute treatment, the degree to which blood pressure should be lowered in the presence of carotid stenosis and the value of antihypertensive treatment in normotensive survivors of stroke. Anticoagulation should be more widely applied in the prevention of stroke in patients with atrial fibrillation. Thrombolysis for acute ischaemic stroke has potential benefits and risks. It should be used only within randomised clinical trials, some of which may soon report. Endogenous glutamate causes excitotoxic damage after cerebral ischaemia. Many pharmacological approaches to restrict neuronal loss within the ischaemic penumbra are now in clinical trials. Physicians managing hypertension should take a lead in researching blood pressure management and neuroprotective strategies after acute stroke, and in directing other preventive measures such as anticoagulation for atrial fibrillation.
University Department of Medicine and Therapeutics, Gardiner Institute Western Infirmary, Glasgow, UK.
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Lees
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Dyker
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Dykes
D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000150:complications