ABC of arterial and venous disease: Secondary prevention of transient ischaemic attack and stroke
Kennedy R Lees, Philip M W Bath, A Ross Naylor
Stroke or transient ischaemic attack is common and likely to be fatal or cause serious disability. A second stroke will not necessarily be of the same type as the initial event, although haemorrhages tend to recur. Patients with previous stroke commonly succumb to other vascular events, in particular myocardial infarction. Effective secondary prevention depends on giving attention to all modifiable risk factors for stroke as well as treating the causes of the initial stroke. Four questions should be answered:
The key features of acute cerebrovascular disease are focal neurological deficit, sudden onset, and absence of an alternative explanation. Abrupt onset of a dense hemiparesis before gradual improvement in a conscious patient rarely causes doubt, but conditions which commonly mimic stroke must be considered (see BMJ 2000;320:920-3).
Magnetic resonance imaging has a greater sensitivity for brain stem, cerebellar, and small ischaemic strokes of the brain than computed tomography. It can also