Drug therapy of neurovascular disease.
Recent advances in the prevention and pharmacotherapy of cerebrovascular disease have provided more favorable clinical outcomes. For the treatment of an acute ischemic stroke, the early use of thrombolytic agents can reduce the degree of brain damage while improving functional outcomes. However, trials evaluating various classes of other neuroprotective agents have not shown benefit to date. For the prevention of second stroke, the use of antiplatelet drugs, HMG-CoA reductase inhibitors, and angiotensin-converting enzyme inhibitors with a diuretic have shown benefit in reducing new events. In patients with underlying heart disease or atrial fibrillation, warfarin appears to be the drug of choice in preventing stroke. Early treatment of hemorrhagic stroke with calcium channel blockers can improve the functional outcome. Innovative therapies are now available for the treatment of migraine and vascular dementia. Primary prevention of stroke remains the optimal therapeutic strategy and includes treatment of systemic hypertension and hypercholesterolemia.
Weinberger
Jesse
J
Department of Neurology, Mt. Sinai Medical Center, New York, New York, USA. jesswein@pol.net
Frishman
William H
WH
Terashita
Dawn
D
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000188:drug therapy; D001929:Brain Edema / Q000188:drug therapy / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D015140:Dementia, Vascular / Q000188:drug therapy / Q000209:etiology; D004827:Epilepsy / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications / Q000188:drug therapy; D018696:Neuroprotective Agents / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy; D013923:Thromboembolism / Q000150:complications / Q000188:drug therapy
D000925:Anticoagulants; D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D018696:Neuroprotective Agents; D010975:Platelet Aggregation Inhibitors