Summary
Stroke is a major cause of death and disability in industrialised countries. Research has indicated the importance of the time window for intervention with regard to limiting ischaemic and inflammatory injury. Data from recent large therapeutic trials indicate that treatment with recombinant tissue plasminogen activator improves outcome after stroke when given within 3 hours of onset to carefully selected patients. Restoration of perfusion pressure, haemorrheological therapy and anticoagulation are used to limit functional damage. Little is known about effective prevention of ischaemic brain oedema, and the efficacy of current antioedematous management is unproven. Secondary prevention of acute ischaemic attacks is achieved by platelet inhibitors or oral anticoagulation.
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References
Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274: 1017–25
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581–7
Adams Jr HP, Brett TG, Furlan AJ, et al. Guidelines for thrombolytic therapy for acute stroke: a supplement to the guidelines for the management of patients with acute ischemic stroke. Stroke 1996; 27: 1711–8
Multicenter Acute Stroke Trial: Italy (MAST-I) group. Randomised controlled trial of streptokinase, aspirin and combination of both in treatment of acute ischemic stroke. Lancet 1995; 346: 1509–14
Hartmann A, Buttinger C, Rommel Th, et al. Alteration of intracranial pressure, cerebral blood flow, autoregulation and carbon dioxide reactivity by hypotensive agents in baboons with intracranial hypertension. Neurochirurgia 1989; 32: 37–43
Schütz HJ, Hartmann A, Alberti E, et al. Einfluss von Furosemid, Spironolacton und 6-Methylprednosolon auf den Liquordruck Med Welt 1982; 33: 1054–1056
Singbartl G, Metzger G. Urapadil-induced increase of the intracranial pressure in head trauma patients. Intensive Care Med 1990; 16: 272–4
Griffin JP, et al. Intracranial pressure during nifedipine-induced hypotension. Anesth Analg 1983; 62: 1078–80
Tateishi A, et al. Effects of nifedipine on intracranial pressure in neurosurgical patients with arterial hypertension. J Neurosurg 1988; 69: 213–5
Grotta J. Present status of hemodilution in acute cerebral ischemia. Stroke 1987; 18: 689–90
The Hemodilution in Stroke Study Group. Hypervolemic hemodilution treatment of acute stroke. Stroke 1989; 20: 317–23
Asplund K, Eriksson S. Multicenter trial of hemodilution in acute ischemic stroke. In: Hartmann A, Kuschinsky W, editors. Cerebral ischemia and hemorrheology. Heidelberg: Springer Verlag, 1987: 472–86
Schwab S, Spranger M, Aschoff A, et al. Brain temperature monitoring and modulation in patients with severe MCA infarction. Neurology 1997; 48(3): 762–7
Hsu CY, Norris JW, Hogan EL, et al. Pentoxyfylline in acute nonhemorrhagic stroke. A randomized placebo-controlled double-blind trial. Stroke 1988; 19: 716–22
Orgogozo JM, Lehert Ph, Mosnier M. Double-blind study of naftidrofuryl on neurological and functional outcome after middle cerebral artery infarction. J Cerebrovasc Dis. In press
The International Stroke Trial: a randomized trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet 1997; 349: 1569–81
Marsh EF, Adams HP, Biller J, et al. Use of antithrombotic drugs in the treatment of acute ischemic stroke. Neurology 1989; 39: 1631–4
Cerebral Embolism Task Force. Cardiogenic brain embolism. Arch Neurol 1989; 46: 727–43
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; I: 175–9
Stroke Prevention in Atrial Fibrillation Investigators. Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation 1991; 84: 527–39
The 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: 1505–11
EAFT (European Atrial Fibrillation Trial) study group. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993; 342: 1255–62
Antiplatelet Trialists’ Collaboration. Secondary prevention of vascular disease by prolonged antiplatelet treatment. BMJ 1988; 296: 320–31
Gent M, Blakely JA, Easton JD, et al. The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke. Lancet 1989; I: 1215–20
Hass WK, Easton JD, Adams HP, et al. A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke. N Engl J Med 1989; 321: 501–7
The ESPS group. The European Stroke Prevention Study (ESPS). Principal endpoints. Lancet 1987; II: 1351–4
UK-TIA study group. The United Kingdom Transient Ischaemic Attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 1991; 54: 1044–54
European Stroke Prevention Study 2. Dipyridamole and acetyl-salicylic acid in secondary prevention of stroke. J Neurol Sci 1996; 143: 1–13
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Hartmann, A., Dettmers, C. Post-Stroke Management. Dis-Manage-Health-Outcomes 2 (Suppl 1), 30–36 (1997). https://doi.org/10.2165/00115677-199700021-00006
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DOI: https://doi.org/10.2165/00115677-199700021-00006