[Neuroprotection in acute ischemic stroke. Practicability of guidelines for treatment].
BACKGROUND
Fibrinolytic agents are effective in the treatment of acute ischemic stroke. However, logistic and clinical factors limit their use. Neuroprotective drugs pose less risks and can be used even before performance of computed tomography of the brain as they are not detrimental in hemorrhagic stroke. These aspects, in theory, will allow the use of neuroprotective drugs in larger number of patients.


OBJECTIVE
To evaluate the feasibility of a neuroprotection protocol and the potential usefulness of citicoline in acute ischemic stroke.


METHODS
Thirty seven patients admitted with a clinical diagnosis of acute ischemic stroke (later confirmed with computed tomography) received, within 12 hours of onset of symptoms, citicoline 500 mg intravenously in a single bolus daily for 7 days. Neurological outcome in this group was compared with a group of 37 patients admitted during the 6 month period before the initiation of the trial and not treated with citicoline. Groups were matched by National Institute of Health Stroke Scale (NIHSS) on admission.


RESULTS
Patients treated with citicoline (aged 69+/-14 years) improved on their NIHSS from admission (5.7+/-4.2) to discharge (4.7+/-4.5), p= 0.015. The control group (aged 60+/-17 years) did not change between admission (5.7+/-4.3) and discharge (5.2+/-3.5), ns. Patients treated within 6 hours of admission (n= 12) had more substantial improvement, from 5.4+/-2.3 on admission to 3.9+/-2.9 at discharge, p= 0.008. There were no differences in vascular risk factor profile between the groups. Citicoline was well tolerated in every subject.


CONCLUSIONS
A protocol of acute stroke management using neuroprotective agents presents clear logistic advantages allowing the inclusion of larger number of patients. Citicoline appears as a safe and potentially effective option.
Fridman
E A
EA
Instituto de Investigaciones Neurológicas Dr. Raúl, Buenos Aires, 1428, Argentina.
Ottaviano
F
F
Fiol
M
M
Javelier
A
A
Perea
J E
JE
Ameriso
S F
SF
D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D003566:Cytidine Diphosphate Choline / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D018697:Nootropic Agents / Q000627:therapeutic use*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
D018696:Neuroprotective Agents; D018697:Nootropic Agents; D003566:Cytidine Diphosphate Choline