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May 2002

Treatment of Patients With Stroke

Arch Neurol. 2002;59(5):703-707. doi:10.1001/archneur.59.5.703

ALTHOUGH THE FIELD of stroke therapeutics has advanced since my last Archives of Neurology review 5 years ago,1 knowledge about treatment of specific cerebrovascular conditions has not yet caught up with the advances in diagnostic technology.

The most important therapeutic advance during the past decade in the treatment of patients with acute stroke has been the development of stroke services and stroke units. Dedicated stroke units have been shown to decrease mortality, limit stroke morbidity, and allow more patients to retain their independence and return home after a stroke.2,3 Between the conduct of the 2 large European thrombolytic trials (European Cooperative Acute Stroke Study [ECASS]4 and ECASS II5), neurologists in the hospitals engaging in these trials developed dedicated stroke units. As a result, the morbidity rate in both the thrombolytic treatment and placebo groups improved dramatically in the ECASS II trial, and the good results in the placebo-treated group exceeded those of any prior thrombolytic trial. Stroke units deliver specialized nursing care, manage blood pressure and fluid volumes, develop protocols and practices to facilitate rapid and thorough evaluation and treatment, monitor treatment, carry out randomized therapeutic trials, prevent complications, and educate patients and families about stroke, its prevention, and early rehabilitation.

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