Stroke

Acute stroke and transient ischaemic attack (TIA) are focal neurological syndromes of vascular origin and should be treated as medical emergencies. Brain imaging with computed tomography or magnetic resonance imaging is required to identify ischaemia from haemorrhage, recognize non-stroke pathologies that mimic stroke and guide investigation for underlying mechanism. Acute interventions of benefit in ischaemic stroke include intravenous thrombolysis with alteplase given within 4.5 hours of onset, stroke unit care and aspirin. Decompressive hemicraniectomy reduces mortality in ischaemic stroke complicated by severe brain swelling. Intracerebral haemorrhage accounts for 10% of strokes, and while specific treatments are lacking at present, patients benefit from general measures, notably stroke unit care. Transient ischaemic attack carries a high short-term risk of stroke, and immediate investigation and institution of secondary preventative treatment prevents a high proportion of these events. Secondary prevention for ischaemic stroke and TIA should be tailored according to mechanism in the individual patient and includes anti-platelet therapies, blood-pressure-lowering, statins, carotid endarterectomy and anticoagulation.