Stroke and TIA

Almost all strokes are caused either by haemorrhage from a blood vessel or by ischaemia due to blockage of a vessel as a result of atherosclerotic plaques or an embolus from another vessel. The distinction between haemorrhagic and ischaemic strokes is critical in stroke diagnosis because both acute and preventative treatments often carry a risk of haemorrhage, which would be detrimental in the setting of haemorrhagic stroke. Various diagnostic methods are used after acute stroke, amongst which cranial computed tomography is the most important. Magnetic resonance imaging, ultrasound studies, electrocardiography and laboratory tests are also used for diagnosis in order to determine the most appropriate treatments.

Guidelines are widely used to ensure the quality of treatment. For secondary prevention of stroke anticoagulation is recommended therapy after cardioembolic stroke, and antiplatelet agents for recurrent stroke prevention in all other situations.

Although treatment of risk factors and secondary prevention are helpful in preventing first or new strokes, these events continue to happen. Patients at high risk of a second stroke with all its consequences need effective preventive treatment. The vascular pathobiology of ischaemic stroke involves multiple factors, and antithrombotic mechanisms in the cerebrovascular microenvironment, beyond platelet inhibition, are now being considered as a possible means of further reducing ischaemic stroke.

To improve outcomes in stroke patients important studies on acute stroke treatment and secondary prevention of stroke are carried out.