[Stroke: acute treatments and secondary prevention]

Stroke unit care is effective to reduce mortality and handicap in all types of strokes. In ischaemic strokes t-PA within 3 hours is the standard therapy, replaced by aspirin 300 mg when not appropriate. In haemorrhagic stroke, blood pressure lowering is recommended although there is no evidence-based data showing that it improves the clinical outcome, and coagulation factors are recommended in patients under oral anticoagulation. Vascular risk factors should be treated to prevent stroke, especially high blood pressure, high blood cholesterol, and cigarette smoking. To reduce the risk of any new vascular events after a first stroke or TIA, the 3 complementary strategies are: an optimal management of risk factors for stroke (for all types of strokes and TIA), an antithrombotic therapy (in ischaemic stroke and TIA only), and carotid surgery in severe symptomatic stenosis.