Update on stroke

Purpose of review: This review highlights some advances in the areas of epidemiology, therapy, and imaging of acute stroke. Recent findings: Studies published in 2003 provided new insights into the epidemiology of stroke. The African American Antiplatelet Stroke Prevention Study found that traditional stroke risk factors are still undiagnosed and undertreated, particularly in minorities. Cohort studies have identified incident silent infarcts as risk factors for stroke and history of type I diabetes as a risk factor for death in patients with acute stroke. Cervical artery dissection, on the other hand, seems to have a benign course. Imaging has become an important tool for understanding the pathophysiology of stroke, as demonstrated in recent publications. New studies have shown the prognostic value of magnetic resonance imaging: it can predict the volume of ischemic tissue that will progress to infarction and detects cerebral microbleeds - a risk factor for intracranial hemorrhage. Computed tomographic scanning may have a role in selecting patients for thrombolysis, particularly when validated scales are used. Despite the barriers to the use of tissue plasminogen activator in the treatment of patients with stroke, data published this year show that it is a safe medication when used routinely in community and university hospitals. In addition to thrombolysis, other general medical measures, such as glucose control and adequate attention to nutritional status, can help improve the outcome of patients with stroke. Summary: In acute stroke, recognition and modification of risk factors continue to be challenging tasks. Treatment of acute stroke should involve thrombolysis and attention to medical conditions that may influence outcome. New applications of magnetic resonance imaging and computed tomography may help guide stroke therapy.