[Acute stroke: early diagnosis, management, and treatment]

Stroke is a major cause of death and disability. The resulting burden on society continues to grow, despite recent advances in acute stroke therapy. Acute stroke units, which allow for the greatest overall improvement in outcome, provide the best facilities for acute intervention. Despite recent advances in acute management, such as endarterectomy and anticoagulation, primary and secondary preventive measures to control stroke risk factors, along with appropriate specific interventions, are the keys to reducing the overall burden of stroke. Thrombolysis reduces stroke morbidity but is only applicable to a small percentage of stroke patients. Intravenous tissue-plasminogen activator (tPA) was the first treatment demonstrated in a randomized controlled trial to improve outcome if given within the first 3 hours of stroke onset. Subsequent trials failed to extend the time window for intravenous therapy beyond 3 hours. For the millions of stroke survivors, investigations are now underway into the possibility of improvement of function through neuronal transplantation.