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July 1993

Stroke Therapy: An Intervention in Time May Save Nine

Arch Neurol. 1993;50(7):770. doi:10.1001/archneur.1993.00540070082021

The easiest way to make a complex problem simple is to leave the difficult parts out. Hallenbeck and Frerichs review 26 experimental articles that focus on only one aspect of cerebral ischemia, while acknowledging but ignoring all others. Such monorail approaches are exemplified by the enthusiasm for calcium channel blockers and more recently for N-methyl-d-aspartate (NMDA) and kainate-AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazole prioprionate) preceptor antagonists.

The authors propose the novel alternative that cerebral ischemia is not a process dominated by a single major step but by a constellation of minor factors. Since much remains to be clarified, it is difficult to say whether all factors are minor, but it is already evident that no one aspect can be treated in isolation from the others.

Experimental and some clinical evidence suggest that ischemic brain can remain functionless but viable for a matter of hours.1 Clearly, the key to successful therapy

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