title: Stroke: acute stroke receiving facilities and management.
abstract: OBJECTIVE
  Management of ischemic stroke is challenging. No prehospital treatment option exists, and the only approved pharmacologic therapy, that is, systemic thrombolysis, requires brain imaging and initiation of therapy within a narrow therapeutic window. This review provides an overview of recent efforts to optimize management of suspected stroke patients by reducing the interval from symptom onset to reperfusion therapy.
  
  
  RESULTS
  There is clear evidence that stroke patients have a favorable outcome when treated with thrombolysis in specialized stroke centers. Data from the European Cooperative Acute Stroke Study-III trial, coupled with improved patient selection by advanced imaging technologies will expand future therapeutic options. However, major obstacles remain in consistently translating scientific advances into clinical practice with only a small percentage of potentially eligible patients receiving thrombolysis. Integrated systems of prehospital management and clinical pathways are necessary to reduce this treatment gap.
  
  
  CONCLUSIONS
  The dogma 'time is brain' is as relevant now as it was at the inauguration of recombinant tissue plasminogen activator for acute stroke treatment in 1996. Knowledge of stroke symptoms and treatment options by the public and first responders, along with integrated stroke systems of care are crucial to ensure rapid access to stroke expertise and treatment.
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine, and Pain Management, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, Frankfurt am Main D-60590, Germany. m.humpich@em.uni-frankfurt.de
authors.forename: Marek
authors.initials: M
authors.lastname: Humpich
authors.forename: Christian
authors.initials: C
authors.lastname: Byhahn
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Fowler
authors.forename: Lise
authors.initials: L
authors.lastname: Labiche
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D010346:Patient Care Management / Q000592:standards*; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy