Acute stroke and transient ischaemic attack
Hugh Markus reviews the latest guidelines for diagnosis and initial management
Stroke is a big cause of mortality and the biggest cause of adult neurological disability in most rich countries. As well as a personal burden to carers and their families, it represents a huge financial burden to economies worldwide. The annual cost in England was estimated to be £7bn (€7.4bn; $10bn) in 2005.1 This burden will increase with the increasing proportion of elderly people in most populations.
About 80% of stroke is ischaemic, and 20% is the result of cerebral haemorrhage. Substantial progress has been made in the management of acute stroke and prevention of recurrent stroke. In acute stroke, randomised clinical trials have shown that both intravenous thrombolysis and organised care by stroke units improve outcome. Reduction of risk factors, antithrombotic drugs, and surgical interventions have been shown to be effective in secondary prevention.
Implementing these advances presents clinical challenges. Intravenous thrombolysis for ischaemic stroke has shown to improve