Reducing post-stroke disability in diabetic patients

Stroke is the main cause of acquired disability in adults and is particularly frequent in diabetic patients. Recent data have shown that stroke-related disability may be substantially reduced by emergency treatment of acute stroke in dedicated stroke units and by rapid management of transient ischaemic attack (TIA) and minor strokes, which remain too often neglected. Simple clinical scores have been developed to improve pre-hospital diagnosis of acute stroke and risk estimation in patients with TIA or minor stroke. They are simple enough to be adapted in patient education programs and stroke education may reduce stroke-related disability by increasing the number of patients immediately seeking appropriate stroke care. Immediate access to diffusion MRI and intra-cranial MR angiography further improves diagnosis and risk estimation in TIA and minor stroke. Urgent investigations should also include systematic non-invasive and high quality detection of severe carotid stenosis, which requires rapid endarterectomy, and of permanent or paroxysmal atrial fibrillation (AF), which requires oral anticoagulation.