Neuroprotection in acute stroke.
OBJECTIVE
To highlight recent advances in neuroprotection in acute stroke.


METHODS
A MEDLINE search was conducted from January 1985 to November 2000. Key words included neuroprotection, cerebrovascular, subarachnoid haemorrhage, perioperative stroke, hypothermia and apopotosis. All articles in English were considered for review. Additional articles were identified from the references of the retrieved articles and cross-referencing selected articles.


METHODS
All clinical studies and review articles and abstracts were reviewed.


RESULTS
The neuronal cells of the central nervous system are susceptible to various forms of insult such as ischaemia and haemorrhage. Each step along the ischaemic cascade is a potential target for therapeutic intervention. Neuroprotective agents are designed to minimise cellular injury and salvage brain tissue. In cerebral ischaemia, only thrombolysis had been shown to improve clinical outcome. Neuroprotective therapy has definite benefits in animals but not in humans. It may potentially extend the time window for thrombolysis. In aneurysmal subarachnoid haemorrhage, the only agent with proven efficacy is nimodipine. Research is ongoing in the development of new drugs. Currently several phase III trials are in progress.


CONCLUSIONS
There is substantial optimism in the development of neuroprotective therapy to improve outcome in stroke patients.
Chua
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HC
Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433. hoe_chin_chua@notes.ttsh.gov.sg
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D006801:Humans; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology*
D018696:Neuroprotective Agents