Current treatments in neurology: stroke

There have been major advances in stroke treatment based on robust evidence from large clinical trials. This review covers both acute treatment and secondary prevention. Thrombolysis is now established as a therapy for ischaemic stroke presenting within 3 hours, and the possibility of extending the time window and refining the selection of suitable patients, is being addressed in further trials. Anticoagulants are of proven benefit in cardioembolic stroke, and particularly atrial fibrillation. For prevention of other stroke subtypes antiplatelet agents appear to have a better risk-benefit ratio. Evidence for the use of dual antiplatelet therapy, including the recent MATCH study, are discussed. Carotid endarterectomy is of proven benefit in patients with>70% symptomatic stenosis. Recent analysis has emphasised the importance of operating as soon after symptom onset as possible. Operating on asymptomatic carotid stenosis remains controversial; even after the recent Asymptomatic Carotid Surgery Trial which showed that by operating on 32 people one disabling stroke or death could be prevented over a 5 years period.