[Treatment of acute stroke]

Ischemic stroke is the first cause of invalidity and the third cause of death in modern day society. The final outcome after a stroke depends of the speed with which treatment is administered and its quality. It is for this reason that the treatment of stroke begins by applying strategies to reduce the delay in receiving medical attention both outside and inside the hospital. Care includes stabilising the patient, with special attention being given to protecting the air passages, treatment of arterial blood pressure and heartbeat rate. The initial evaluation must be quick and focused on determining a differential diagnosis, the estimation of the volume and location of the infarction, as well as considering specific therapies. Amongst the latter, the only one currently approved is thrombolysis with intravenous recombinant tissue plasminogen activator (rtPA) in selected patients and with a clinical course of less than three hours duration. Intra arterial thrombolysis is a promising therapy for patients with occlusion of the middle cerebral artery, which has been contrasted angiographically and is less than 6 hours old.

In these moments there is no evidence to support the use of antithrombotic or neuroprotector drugs to improve the neurological state. Following the initial stabilisation and evaluation, it is advisable for the patient to be admitted to a stroke unit in order to avoid complications, to complete the evaluation and to start secondary prevention and rehabilitation. Stroke units are an intervention in themselves, since they lower mortality and invalidity. While only a minority of patients currently benefit from specific therapies, stroke units are an intervention that can potentially have positive repercussions on the huge majority of patients