[Treatment of patients with a TIA or a stroke].
Patients in the acute phase of a stroke ought to be sent to a centre with a well-organised 'stroke unit' where thrombolysis is possible. The integrated approach at a stroke unit is associated with a better outcome than treatment in a general neurology ward. Intravenous thrombolysis can be carried out responsibly if the treatment is started within 3 hours of the onset of clinical symptoms and if certain conditions are satisfied. However, preventive measures provide the greatest benefit to patients who have experienced a transient ischaemic attack (TIA) or a minor stroke. The treatment of vascular risk factors should therefore receive the greatest priority. In addition to the classical risk factors, hyperhomocysteinaemia, infection with Chlamydia pneumoniae and obesity have all recently been indicated as potential risk factors. For patients with a potential source of embolism in the heart, oral anticoagulants are the treatment of choice, whereas platelet aggregation inhibitors should be the first choice for patients with atherosclerotic lesions in the extracranial vessels. Carotid endarterectomy is now a regular form of secondary prevention, whereas the role of endovascular treatment is currently under investigation.
Kappelle
L J
LJ
Universitair Medisch Centrum Utrecht, afd. Neurologie, Postbus 85.500, 3508 GA Utrecht. l.kappelle@neuro.azu.nl
Frijns
C J M
CJ
D000925:Anticoagulants / Q000627:therapeutic use*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control / Q000628:therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors