["Brain attack"--care during the acute phase is crucial for the long term outcome]

Brain attack should be considered as an urgent condition, comparable with acute coronary syndrome. It is important that patients with an evolving stroke should seek medical attention at a hospital as soon as possible in order to receive thrombolysis for a few, to elucidate complicating conditions and to get access to stroke unit care. The Scandinavian model with non-intensive stroke units and coordinated continuously educated multidisciplinary teams with immediate mobilisation and early rehabilitation reduces death, dependency and required in-hospital days. These positive effects are independent of patient's age, sex or degree of brain damage. Attempts to reduce the extent of brain damage with neuroprotectants have so far been without success, some future strategies test the effects of combined thrombolysis and neuroprotectants. There is evidence that acute stroke patients should be monitored regularly during the acute phase aiming at normalized physiological conditions. This means that hypoxemia, dehydration, hyperthermia, hyperglycemia and hypotension should be prevented and if occurring, promptly corrected.