Medical management of ischaemic stroke.

Stroke is a medical emergency as it is the third commonest cause of death and the most important cause of acquired severe disability in adults. Stroke services, funding and research have lagged behind cardiac medicine but evidence is now available to support a much more interventional approach to the assessment and management of patients with ischaemic stroke. Randomised controlled trials and meta-analyses of the most important interventions are the main sources of evidence for this review. This evidence supports the immediate assessment of patients with suspected stroke, including access to brain imaging, and consideration of urgent revascularisation strategies such as intravenous recombinant tissue plasminogen activator. Patients not eligible for thrombolysis should receive aspirin and specialised care in a stroke unit. Many other treatments have been evaluated for acute ischaemic stroke of which some have been shown to be ineffective such as haemodilution or anticoagulation, whilst other interventions have not been adequately investigated such as neuroprotection and blood pressure lowering strategies. There is now good evidence to support a much more active assessment and treatment of patients with stroke but it is recognised that stroke services still need substantial development to maximise the benefits from the current proven interventions.