Time is brain--acute stroke management

In recent years, four specific strategies have emerged which have proven clinical benefit in treating acute stroke. These are the administration of tissue plasminogen activator (tPA), aspirin, management in a stroke care unit (SCU) and the use of hemicraniectomy in patients with severe cerebral oedema.

This article discusses current management strategies and evidence with emphasis on the role of the general practitioner in initial diagnosis and hospitalisation.

Although tPA has been shown to be remarkably clinically effective, less than 5% of eligible stroke patients receive this therapy. The main obstacle is its very narrow therapeutic time window of 3 hours. This necessitates the immediate recognition of stroke and rapid transfer to hospital. Computerised tomography is mandatory to rule out cerebral haemorrhage. Starting aspirin within 48 hours of stroke onset in patients with ischaemic stroke results in a significant reduction in mortality and morbidity. Management in a SCU is the most useful intervention with significant reductions in mortality and morbidity for all stroke subtypes. The management of stroke is changing, and the role of the GP is crucial in facilitating the rapid transfer of patients to a SCU together with subsequent risk factor control and community support.