ACUTE CEREBRAL INFARCTION - OPTIMAL MANAGEMENT IN OLDER PATIENTS

The optimal management of acute cerebral infarction requires considera tion of the diagnosis, aetiology, identification of problems, general and specific aspects of care, and prevention of further vascular event s, Stroke is a clinical diagnosis but cranial computed tomography (CT) scanning is invaluable to exclude the possibility of cerebral haemorr hage or where the diagnosis is uncertain. Good general care under a sp ecialist multidisciplinary team can reduce mortality and the need for institutional care, Despite promising results from experimental studie s, no routine drug therapies have yet shown clinical benefit in acute stroke. Several large trials are currently evaluating anticoagulant, a ntiplatelet, thrombolytic and neuroprotective agents, Many other propo sed therapies have been subject to limited evaluation, Aspirin has a p roven role in the prevention of further vascular events after a stroke or transient ischaemic attack, Warfarin, and to a lesser extent aspir in, can prevent recurrent events in patients with nonrheumatic atrial fibrillation, Concerns remain about the safety of warfarin in routine geriatric medical practice. The risk of recurrent stroke in patients w ith a symptomatic severe carotid artery stenosis is greatly reduced by endarterectomy.