Summary
The optimal management of acute cerebral infarction requires consideration of the diagnosis, aetiology, identification of problems, general and specific aspects of care, and prevention of further vascular events. Stroke is a clinical diagnosis but cranial computed tomography (CT) scanning is invaluable to exclude the possibility of cerebral haemorrhage or where the diagnosis is uncertain. Good general care under a specialist multidisciplinary team can reduce mortality and the need for institutional care.
Despite promising results from experimental studies, no routine drug therapies have yet shown clinical benefit in acute stroke. Several large trials are currently evaluating anticoagulant, antiplatelet, thrombolytic and neuroprotective agents. Many other proposed therapies have been subject to limited evaluation.
Aspirin has a proven role in the prevention of further vascular events after a stroke or transient ischaemic attack. Warfarin, and to a lesser extent aspirin, can prevent recurrent events in patients with nonrheumatic atrial fibrillation. Concerns remain about the safety of warfarin in routine geriatric medical practice. The risk of recurrent stroke in patients with a symptomatic severe carotid artery stenosis is greatly reduced by endarterectomy.
Similar content being viewed by others
References
Warlow C. Disorders of the cerebral circulation. In: Walton J (editor). Brain’s diseases of the nervous system. 10th ed. Oxford: Oxford University Press, 1993
Bonita R. Epidemiology of stroke. Lancet 1992; 339: 342–4
Sandercock PAG, Allen CMC, Corston RN, et al. Clinical diagnosis of intracranial haemorrhage using the Guys Hospital score. BMJ 1985; 291: 1675–7
Weir CJ, Murray GD, Adams FG, et al. Poor accuracy of stroke scoring systems for differential clinical diagnosis of intracranial haemorrhage and infarction. Lancet 1994; 344: 999–1002
van Gijn J. Subarachnoid haemorrhage. Lancet 1992; 339: 653–5
Wade D. Measurement in neurological rehabilitation. Oxford: Oxford University Press, 1992
Kidd D, Lawson J, Nesbitt R, et al. Aspiration in acute stroke: a clinical study with videofluoroscopy. Q J Med 1993; 86: 825–9
Barer DH. The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry 1989; 52: 236–41
Langhorne P, Williams BO, Gilchrist W, et al. Do stroke units save lives? Lancet 1993; 342: 395–8
Langhorne P, Dennis MS, Williams BO. Stroke units: their role in acute stroke management. Vasc Med Rev 1995; 6: 23–34
Dennis M, Langhorne P. So stroke units save lives: where do we go from here? BMJ 1994; 309: 1273–7
Sandercock PAG, Willems H. Medical treatment of acute ischaemic stroke. Lancet 1992; 339: 537–9
Pusinelli W. Pathophysiology of acute ischaemic stroke. Lancet 1992; 339: 533–6
Wardlaw JM, Warlow CP. Thrombolysis in acute ischaemic stroke: does it work? Stroke 1992; 23: 1826–39
Antiplatelet Trialists’ Collaboration. Collaborative overview of randomised trials of antiplatelet therapy — I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994; 308: 81–106
Sandercock PAG, van den Belt AGM, Lindley RI, et al. Antithrombotic therapy in acute ischaemic stroke: an overview of the randomised trials. J Neurol Neurosurg Psychiatry 1993; 56: 17–25
Simoons ML, Maggioni AP, Knatterud G, et al. Individual risk assessment for intracranial haemorrhage during thrombolytic therapy. Lancet 1993; 342: 1523–8
Hommel M, Boissel JP, Cornu C, et al. Termination of trial of streptokinase in severe ischaemic stroke. Lancet 1995; 345: 57
Donnan GA, Davis SM, Chambers BR, et al. Trials of streptokinase in severe acute ischaemic stroke. Lancet 1995; 345: 578–9
Asplund K. Haemodilution in acute stroke. Cerebrovasc Dis 1991; 1 Suppl. 1: 129–38
Counsell C, Sandercock P. The management of patients with acute ischaemic stroke. Curr Med Lit: Geriatr 1994; 7(4): 99–104
Pickhard JD, Murray GD, Illingworth R, et al. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ 1989; 298: 636–42
Mohr JP, Orgogozo JM, Hennerici M, et al. Meta-analysis of nimodipine trials in acute ischaemic stroke. Cerebrovasc Dis 1994; 4: 197–203
Bridgers SL, Koch G, Munera C, et al. Intravenous nimodipine in acute stroke: interim analysis of randomized trials. Stroke 1991; 22: 153
Wahlgren NG, MacMahon DG, de Keyser J, et al. Intravenous Nimodipine West European Stroke Trial (INWEST) of nimodipine in the treatment of acute ischaemic stroke. Cerebrovasc Dis 1994; 4: 194–6
Quizilbash N, Murphy M. Meta-analysis of trials of corticosteroids in acute stroke. Age Ageing 1993; 22 Suppl. 2: 4
Rogvi-Hansen B, Boysen G. Intravenous glycerol treatment of acute stroke — a statistical overview. Cerebrovasc Dis 1992; 2: 11–3
Burns J, Dennis MS, Bamford J, et al. Long-term risk of recurrent stroke after a first ever stroke: the Oxfordshire Community Stroke Project. Stroke 1994; 25: 333–7
Warlow CP. Venous thromboembolism after stroke. Am Heart J 1978; 96: 283–9
Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease: part 2. Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 1990; 335: 827–38
Carter AB. Hypotensive therapy in stroke survivors. Lancet 1970; 1: 485–9
Hypertension-Stroke Co-operative Study Group. Effect of anti-hypertensive treatment on stroke recurrence. JAMA 1974; 229: 409–18
Lisk DR, Grotta JC, Lamki LM, et al. Should hypertension be treated after acute stroke? A randomised controlled trial using single photon emission computed tomography. Arch Neurol 1993; 50: 855–62
Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–9
Petersen P, Boysen G, Godtfredsen J, et al. Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFASAK study. Lancet 1989; 1: 175–8
Stroke Prevention in Atrial Fibrillation Investigators. Stroke prevention in atrial fibrillation study: final results. Circulation 1991; 84: 527
Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med 1990; 323: 1505
Connolly SJ, Laupacis A, Gent M, et al. Canadian atrial fibrillation anticoagulation (CAFA) study. J Am Coll Cardiol 1991; 18: 349
Ezakowitz MD, Bridgers SL, James KE, et al. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. N Engl J Med 1992; 327: 1406–12
European Atrial Fibrillation Trial Study Group. Secondary prevention in nonrheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993; 342: 1255–62
Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994; 154: 1449–57
Major ongoing stroke trials. Stroke 1994; 25 (2): 541-5
Wells PS, Lensing AWA, Hirsh J. Graduated compression stockings in the prevention of postoperative venous thromboembolism: a meta-analysis. Ann Intern Med 1994; 154: 67–72
Antiplatelet Trialists’ Collaboration. Collaborative overview of randomised trials of antiplatelet treatment: part 3. Reduction in pulmonary embolism and venous thrombosis by antiplatelet prophylaxis among surgical and medical patients. BMJ 1994; 304: 235–46
European Carotid Surgery Trial Collaborative Group. Medical Research Council Carotid Surgery Trial: interim results for patients with severe (70–99%) or with mild (0–30%) carotid stenosis. Lancet 1989; 1: 175–80
NASCET Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high grade stenosis. N Engl J Med 1991; 325: 445–53
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Langhorne, P., Stott, D.J. Acute Cerebral Infarction. Drugs & Aging 6, 445–455 (1995). https://doi.org/10.2165/00002512-199506060-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00002512-199506060-00004