[The practice guideline 'CVA' from the Dutch College of General Practitioners; a response from the perspective of neurology].
The practice guideline for the treatment of ischemic stroke, issued by the Dutch College of General Practitioners, is a timely and most welcome update. It incorporates the new evidence and the important changes in stroke treatment of the past years, and is a good starting point for the collaboration between general practitioners and neurologists in the care of patients with a cerebrovascular accident. The guideline acknowledges the evidence for the benefit ofthrombolysis, but is somewhat vague concerning the magnitude of the effect because it compares the net effect of treatment (which incorporates the risk of bleeding) and the number of cerebral haemorrhages. Furthermore, the discussion of minor stroke could lead to the erroneous conclusion that such patients can be safely cared for at home. Apart from these reservations, the guideline fully agrees with the need to treat all patients with a cerebral infarct, in the absence of contraindications, with thrombolysis within three hours, and to offer specialised care in a dedicated stroke-unit.
Stam
J
J
Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Neurologie, Amsterdam. j.stam@amc.uva.nl
D006760:Hospitalization; D006801:Humans; D009426:Netherlands; D009462:Neurology / Q000592:standards*; D010346:Patient Care Management; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D020521:Stroke / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D015912:Thrombolytic Therapy