Preclinical treatment of patients with acute stroke

Stroke is the third leading cause of death and number one cause of disabili ty in industrialised countries. Studies into the pathophysiology of acute i schaemic stroke have indicated that treatment options are likely to be opti mized when early signs of stroke are recognized and treatment is initiated within 3 hours from symptom onset. Therefore, new conceptions heading towar ds early diagnosis, fast preclinical treatment, structured diagnostics, imm ediate initiation of acute therapy as well as early initiation of rehabilit ation are required. It is well known that,for most patients, there is a lon g delay between the onset of symptoms and the sta rt of therapy. Many facto rs are responsible for the time delay:signs and symptoms often go unrecogni zed and/or are minimized by patients, relatives and bystanders. Unlike trau ma or myocardial infarction, stroke is not given a high priority by medical staff and/or emergency medical services (EMS). Although a small number of stroke patients is treated as emergency and attended to by the emergency me dical services within this time window, this number could easily be increas ed by intensified public and emergency personnel education. At present the standard of care by the EMS personnel includes adequate cerebral oxygenatio n, treatment of cardiac arrhythmia, management of hypertension as well as t herapy of hyperglycemia and hyperthermia. For the future, we hope that emer gency medical services will be able to initiate therapies which must be adm inistered within the first few hours of acute stroke after onset of symptom s. Early notification of hospitals would enable a particular stroke team to be present at the patient's admission.