Journal Mobile

D Jarrett
Journal Issue: 
Volume 37: Issue 1: 2007




Stroke is the third most common cause of death worldwide. About 80% of  strokes  are  ischaemic.  The  only  reliable  way  of  distinguishing  cerebral  infarction from  haemorrhage  is  with  neuroimaging, most  commonly  CT  scanning  in  the  UK. The  last  decade  has  produced  a  number  of  RCTs  clarifying  former  areas  of management  uncertainty.  Three  interventions  have  been  shown  to  be  beneficial  in acute stroke: admission to a stroke unit; early aspirin; and intravenous thrombolysis. Aspirin and stroke service admission should be available to all patients, thrombolysis is  of  benefit  to  a  select  minority  of  patients.  Accurate  diagnosis, investigation, and management of physiological variables such as BP, temperature, glycaemia, and oxygen saturation  should  improve  outcome.   Multiprofessional  guidelines  exist  and, when used with education, audit, and other areas of clinical governance, improve the basic standards of care. The National Sentinel Audits of Stroke have repeatedly shown that care is suboptimal. Secondary prevention with anti-platelet drugs (or warfarin in the case of atrial fibrillation), statins, and antihypertensive drugs, reduce recurrent strokes and  other  vascular  events.  Patients  with  70–99%  stenosis  of  the  ipsilateral  carotid bulb or internal carotid artery may benefit from early carotid endarterectomy.