Understanding stroke: Management of acute
Five and a half million survivors of stroke are living in the world today. In the second and final part of the series, K A L Carroll and J Chataway; explain how to manage this emergency
For many years, preventing and managing stroke involved reducing risk factors before the event, supportive treatment through the event, and then rehabilitation after the event. A number of studies have shown that specialist stroke units for rehabilitation greatly increase functional outcome after stroke compared with standard hospital care.1 In follow-up studies over eight years, specialist stroke units for rehabilitation significantly improve outcome in terms of length of stay, death or dependence, and long term hospitalisation.2
In addition, the options for treating ischaemic and perhaps haemorrhagic stroke in the acute setting are also rapidly developing, resulting in a better prognosis. Because the guidelines often change, it is important for students and doctors to not only know about what is currently available but also what is in the pipeline.
Currently, there is no definitely effective targeted treatment for haemorrhagic stroke. Computed tomography shows that the growth of intracerebral haemorrhage within the first