Advertisement

Stroke — acute interventions

  • W.-D. Heiss
Conference paper

Summary

The reduction of blood flow to parts of the brain is the cause of ischemic stroke leading to functional deficits and, if prolonged, to irreversible neurological and morphological defects. The fast reperfusion, therefore is the most important therapeutic strategy and was proven to be effective in clinical trials. Steps to intervene with secondary biochemical, molecular, or inflammatory disturbances were not successful so far. Since direct therapeutic interventions are limited, the general management of the stroke victim is of utmost importance — and was shown to be most successful in dedicated stroke units.

Keywords

Ischemic Stroke Single Photon Emission Compute Tomography Acute Stroke Acute Ischemic Stroke Stroke Unit 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adams HP Jr, Brott TG, Furlan AJ, Gomez CR, Grotta J, Helgason CM, Kwiatkowski T, Lyden PD, Marler JR, Torner J, Feinberg W, Mayberg M, Thies W (1996) Guidelines for thrombolytic therapy for acute stroke: a supplement to the guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Ciculation 94: 1167–1174CrossRefGoogle Scholar
  2. Albers GW (1999) Expanding the window for thrombolytic therapy in acute stroke. The potential role of acute MRI for patient selection. Stroke 30: 2230–2237CrossRefPubMedGoogle Scholar
  3. Albers GW, Bates VE, Clark WM, Bell R, Verro P, Hamilton SA (2000) Intravenous tissue-type plasminogen activator for treatment of acute stroke: the Standard Treatment with Alteplase to Reverse Stroke (STARS) study. JAMA 283: 1145–1150CrossRefPubMedGoogle Scholar
  4. Asplund K (1991) Hemodilution in acute stroke. Cerebrovasc Dis [Suppl]: 129–138Google Scholar
  5. Astrup J, Siesjo BK, Symon L (1981) Thresholds in cerebral ischemia — the ischemic penumbra. Stroke 12: 723–725CrossRefPubMedGoogle Scholar
  6. Barinaga M (1998) Stroke-damaged neurons may commit cellular suicide. Science 281: 1302–1303CrossRefPubMedGoogle Scholar
  7. Baron JC, Bousser MG, Rey A, Guillard A, Comar D, Castaigne P (1981) Reversal of focal “misery-perfusion syndrome” by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 150 positron emission tomography. Stroke 12: 454–459CrossRefPubMedGoogle Scholar
  8. Barone FC, Feuerstein GZ (1999) Inflammatory mediators and stroke: new opportunities for novel therapeutics. J Cereb Blood Flow Metab 19: 819–834CrossRefPubMedGoogle Scholar
  9. Bell WR, Pitney WR, Goodwin JF (1968) Therapeutic defibrination in the treatment of thrombotic disease. Lancet 1: 490–493CrossRefPubMedGoogle Scholar
  10. Bereczki D, Lui M, do Prado GF, Fekete I (2000) A systematic review of mannitol therapy for acute ischemic stroke and cerebral parenchymal hemorrhage. Stroke 31: 2722CrossRefGoogle Scholar
  11. Busto R, Dietrich WD, Globus MY, Ginsberg MD (1989) Postischemic moderate hypothermia inhibits CA1 hippocampal ischemic neuronal injury. Neurosci Lett 101: 299–304CrossRefPubMedGoogle Scholar
  12. Chapman KM, Woolfenden AR, Graeb D, Johnston DC, Beckman J, Schulzer M, Teal PA (2000) Intravenous tissue plasminogen activator for acute ischemic stroke: a Canadian hospital’s experience. Stroke 31: 2920–2924CrossRefPubMedGoogle Scholar
  13. Chiu D, Krieger D, Villar-Cordova C, Kasner SE, Morgenstern LB, Bratina PL, Yatsu FM, Grotta JC (1998) Intravenous tissue plasminogen activator for acute ischemic stroke. Feasibility, safety, and efficacy in the first year of clinical practice. Stroke 29: 18–22CrossRefPubMedGoogle Scholar
  14. Davenport J, Hanson SK, Altafullah IM, Anderson DC, Brauer DJ, Brown RD, Ramirez-Lassepas M (2000) tPA: A rural network experience. Stroke 31: 1457CrossRefPubMedGoogle Scholar
  15. De Keyser J, Suiter G, Luiten PG (1999) Clinical trials with neuroprotective drugs in acute ischaemic stroke: are we doing the right thing? TINS-Trends Neurosci 22: 535–540Google Scholar
  16. del Zoppo GJ, Poeck K, Pessin MS, Wolpert SM, Furlan AJ, Ferbert A, Alberts MJ, Zivin JA, Wechsler L, Busse O, Greenlee R, Brass L, Mohr JP, Feldmann E, Hacke W, Kase CS, Biller J, Gress D, Otis SM (1992) Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. Ann Neurol 32: 78–86CrossRefPubMedGoogle Scholar
  17. Dirnagl U, Iadecola C, Moskowitz MA (1999) Pathobiology of ischaemic stroke: an integrated view. TINS-Trends Neurosci 22: 391–397CrossRefGoogle Scholar
  18. Fieschi C, Argentino C, Lenzi GL, Sacchetti ML, Toni D, Bozzao L (1989) Clinical and instrumental evaluation of patients with ischemic stroke within the first six hours. J Neurol Sci 91: 311–322CrossRefPubMedGoogle Scholar
  19. Fisher M, Albers GW (1999) Applications of diffusion-perfusion magnetic resonance imaging in acute ischemic stroke. Neurology 52: 1750–1756CrossRefPubMedGoogle Scholar
  20. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999) Intra-arterial prourokinase for acute ischemic stroke. The PRO ACT II study: a randomized controlled trial. JAMA-J Am Med Assoc 282: 2003–2011CrossRefGoogle Scholar
  21. Gottstein U (1984) Hemodilution: therapy in acute ischemic stroke. In: Bes A, Braquet P, Paoletti R, Siesjo BK (eds) Cerebral ischemia. Elsevier Science Publishers B.V., Amsterdam, pp 311–324Google Scholar
  22. Grond M, Stenzel C, Schmulling S, Rudolf J, Neveling M, Lechleuthner A, Schneweis S, Heiss W-D (1998) Early intravenous thrombolysis for acute ischemic stroke in a community-based approach. Stroke 29: 1544–1549CrossRefPubMedGoogle Scholar
  23. Grotta J (1994) The current status of neuronal protective therapy: why have all neuronal protective drugs worked in animals but none so far in stroke patients? Cerebrovasc Dis 4: 115–120CrossRefGoogle Scholar
  24. Grotta JC, Alexandrov AV (1998) tPA-Associated reperfusion after acute stroke demonstrated by SPECT. Stroke 29: 429–432CrossRefPubMedGoogle Scholar
  25. Gubitz G, Counsell C, Sandercock P, Signorini D (2001a) Anticoagulants for acute ischaemic stroke (Cochrane Review). The Cochrane Library 3Google Scholar
  26. Gubitz G, Sandercock P, Counsell C (2001b) Antiplatelet therapy for acute ischaemic stroke (Cochrane Review). The Cochrane Library 3Google Scholar
  27. Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Hoxter G, Mahagne MH, Hennerici M (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA-J Am Med Assoc 274:1017–1025CrossRefGoogle Scholar
  28. Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R (1996) “Malignant” middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53: 309–315CrossRefPubMedGoogle Scholar
  29. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischemic stroke (ECASS II). Lancet 352: 1245–1251CrossRefPubMedGoogle Scholar
  30. Hacke W, Brott T, Caplan L, Meier D, Fieschi C, von Kummer R, Donnan G, Heiss W-D, Wahlgren NG, Spranger M, Boysen G, Marler JR (1999) Thrombolysis in acute ischemic stroke: controlled trials and clinical experience. Neurology 53:S3–14CrossRefPubMedGoogle Scholar
  31. Hakim AM (1989) Hemodynamic and metabolic studies in stroke. Semin Neurol 9: 286–292CrossRefGoogle Scholar
  32. Hakim AM, Pokrupa RP, Villanueva J, Diksic M, Evans AC, Thompson CJ, Meyer E, Yamamoto YL, Feindel WH (1987) The effect of spontaneous reperfusion on metabolic function in early human cerebral infarcts. Ann Neurol 21: 279–289CrossRefPubMedGoogle Scholar
  33. Heiss W-D (2000) Ischemic penumbra: evidence from functional imaging in man. J Cereb Blood Flow Metab 20: 1276–1293CrossRefPubMedGoogle Scholar
  34. Heiss W-D, Graf R (1994) The ischemic penumbra. Curr Opin Neurol 7:11–19CrossRefPubMedGoogle Scholar
  35. Heiss W-D, Prosenz P, Tschabitscher H, Lasek C, Herles HJ (1972) Effect of low molecular dextran on total cerebral blood flow and on regional flow within ischemic brain lesions. Eur Neurol 8: 129–133CrossRefPubMedGoogle Scholar
  36. Heiss W-D, Grond M, Thiel A, von Stockhausen HM, Rudolf J, Ghaemi M, Lottgen J, Stenzel C, Pawlik G (1998) Tissue at risk of infarction rescued by early reperfusion: a positron emission tomography study in systemic recombinant tissue plasminogen activator thrombolysis of acute stroke. J Cereb Blood Flow Metab 18: 1298–1307CrossRefPubMedGoogle Scholar
  37. Heiss W-D, Thiel A, Grond M, Graf R (1999) Which targets are relevant for therapy of acute ischemic stroke? Stroke 30: 1486–1489CrossRefPubMedGoogle Scholar
  38. Heiss W-D, Kracht L, Grond M, Rudolf J, Bauer B, Wienhard K, Pawlik G (2000) Early [11C]Flumazenil/H2O positron emission tomography predicts irreversible ischemic cortical damage in stroke patients receiving acute thrombolytic therapy. Stroke 31: 366–369CrossRefPubMedGoogle Scholar
  39. Heiss W-D, Graf R, Wienhard K (2001a) Relevance of experimental ischemia in cats for stroke management: a comparative reevaluation. Cerebrovasc Dis 11: 73–81CrossRefPubMedGoogle Scholar
  40. Heiss W-D, Kracht LW, Thiel A, Grond M, Pawlik G (2001b) Penumbral probability thresholds of cortical flumazenil binding and blood flow predicting tissue outcome in patients with cerebral ischaemia. Brain 124: 20–29CrossRefPubMedGoogle Scholar
  41. Hickenbottom SL, Grotta J (1998) Neuroprotective therapy. Semin Neurol 18: 485–492CrossRefPubMedGoogle Scholar
  42. Hossmann K-A (1994) Viability thresholds and the penumbra of focal ischemia. Ann Neurol 36: 557–565CrossRefPubMedGoogle Scholar
  43. Hossmann V, Heiss W-D, Bewermeyer H, Wiedemann G (1983) Controlled trial of ancrod in ischemic stroke. Arch Neurol 40: 803–808CrossRefPubMedGoogle Scholar
  44. Indredavik B, Bakke F, Slordahl SA, Rokseth R, Haheim LL (1999) Stroke unit treatment. 10-Year follow-up. Stroke 30: 1524–1527CrossRefPubMedGoogle Scholar
  45. Jansen O, Schellinger P, Fiebach J, Hacke W, Sartor K (1999) Early recanalisation in acute ischaemic stroke saves tissue at risk defined by MRI. Lancet 353: 2036–2037CrossRefPubMedGoogle Scholar
  46. Jorgensen HS, Kammersgaard LP, Nakayama H, Raaschou HO, Larsen K, Hubbe P, Olsen TS (1999) Treatment and rehabilitation on a stroke unit improves 5-year survival. A community-based study. Stroke 30: 930–933CrossRefPubMedGoogle Scholar
  47. Kalra L, Evans A, Perez I, Knapp M, Donaldson N, Swift CG (2000) Alternative strategies for stroke care: a prospective randomised controlled trial. Lancet 356: 894–899CrossRefPubMedGoogle Scholar
  48. Karibe H, Chen J, Zarow GJ, Graham SH, Weinstein PR (1994) Delayed induction of mild hypothermia to reduce infarct volume after temporary middle cerebral artery occlusion in rats. J Neurosurg 80: 112–119CrossRefPubMedGoogle Scholar
  49. Kaste M (2001) Thrombolysis in ischaemic stroke — present and future: role of combined therapy. Cerebrovasc Dis 11 [Suppl 1]: 55–59CrossRefPubMedGoogle Scholar
  50. Katzan IL, Furlan AJ, Lloyd LE, Frank JI, Harper DL, Hinchey JA, Hammel JP, Qu A, Sila CA (2000) Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience. JAMA 283: 1151–1158CrossRefPubMedGoogle Scholar
  51. Kidwell CS, Saver JL, Mattiello J, Starkman S, Vinuela F, Duckwiler G, Gobin YP, Jahan R, Vespa P, Kalafut M, Alger JR (2000) Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol 47: 462–469CrossRefPubMedGoogle Scholar
  52. Klotz E, Konig M (1999) Perfusion measurements of the brain: using dynamic CT for the quantitative assessment of cerebral ischemia in acute stroke. Eur J Radiol 30:170–184CrossRefPubMedGoogle Scholar
  53. Koroshetz WJ, Gonzales RG (1999) Imaging stroke in progress: magnetic resonance advances but computed tomography is poised for counterattack. Ann Neurol 46: 556–558CrossRefPubMedGoogle Scholar
  54. Kwiatkowski TG, Libman RB, Frankel M, Tilley BC, Morgenstern LB, Lu M, Broderick JP, Lewandowski CA, Marler JR, Levine SR, Brott T (1999) Effects of tissue plasminogen activator for acute ischemic stroke at one year. National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group. N Engl J Med 340: 1781–1787CrossRefPubMedGoogle Scholar
  55. Lee JM, Zipfel GJ, Choi DW (1999) The changing landscape of ischaemic brain injury mechanisms. Nature 399:A7–A14CrossRefPubMedGoogle Scholar
  56. Lees KR, Asplund K, Carolei A, Davis SM, Diener HC, Kaste M, Orgogozo J-M, Whitehead J (2000) Glycine antagonist (gavestinel) in neuroprotection (GAIN International) in patients with acute stroke: a randomised controlled trial. GAIN International Investigators. Lancet 355: 1949–1954CrossRefPubMedGoogle Scholar
  57. Liebeskind DS, Kasner SE (2001) Neuroprotection for ischaemic stroke: an unattainable goal? CNS Drugs 15: 165–174CrossRefPubMedGoogle Scholar
  58. Marks MP, Tong DC, Beaulieu C, Albers GW, de Crespigny A, Moseley ME (1999) Evaluation of early reperfusion and IV tPA therapy using diffusion-and perfusionweighted MRI. Neurology 52: 1792–1798CrossRefPubMedGoogle Scholar
  59. Mathew NT, Meyer JS, Rivera VM, Charney JZ, Hartmann A (1972) Double-blind evaluation of glycerol treatment in acute cerebral infarction. Lancet ii: 1327–1329CrossRefGoogle Scholar
  60. Olinger CP, Brott TG, Barsan WG, Hedges JR, Glas-Greenwalt P, Pollak VE, Spilker J, Eberle R (1988) Use of ancrod in acute or progressing ischemic cerebral infarction. Ann Emerg Med 17: 1208–1209CrossRefPubMedGoogle Scholar
  61. Orgogozo JM, Verstraete M, Kay R, Hennerici M, Lenzi GL (2000) Outcomes of ancrod in acute ischemic stroke. Independent Data and Safety Monitoring Board for ESTAT. Steering Committee for ESTAT. European Stroke Treatment with Ancrod Trial. JAMA 284: 1926–1927CrossRefPubMedGoogle Scholar
  62. Plum F (2001) Neuroprotection in acute ischemic stroke. JAMA 285: 1760–1761CrossRefPubMedGoogle Scholar
  63. Pollak VE, Glas-Greenwalt P, Olinger CP, Wadhwa NK, Myre SA (1990) Ancrod causes rapid thrombolysis in patients with acute stroke. Am J Med Sci 299: 319–325CrossRefPubMedGoogle Scholar
  64. Restrepo L, Silverman IE (2001) Osmotherapy: a call to arms. Stroke 32: 811–812CrossRefPubMedGoogle Scholar
  65. Righetti E, Celani MG, Cantisani T, Sterzi R, Boysen G, Ricci S (2000) Glycerol for acute stroke (Cochrane Review). The Cochrane Library 3Google Scholar
  66. Rubin G, Firlik AD, Pindzola RR, Levy EI, Yonas H (1999) The effect of reperfusion therapy on cerebral blood flow in acute stroke. J Stroke Cerebrovasc Dis 8: 1–9CrossRefGoogle Scholar
  67. Rudolf J, et al (2002) Hydroxyethyl starch for hypervolemic hemodilution in patients with acute ischemic stroke — a randomized, placebo-controlled phase II safety study. Cerebrovasc Dis 14: 33–41CrossRefPubMedGoogle Scholar
  68. Ryu YH, Chung TS, Yoon PH, Kim DI, Lee JD, Lee BI, Suh JH (1999) Evaluation of reperfusion and recovery of brain function before and after intracarotid arterial urokinase therapy in acute cerebral infarction with brain SPECT. Clin Nucl Med 24: 566–571CrossRefPubMedGoogle Scholar
  69. Sacco RL, DeRosa JT, Haley EC, Jr, Levin B, Ordronneau P, Phillips SJ, Rundek T, Snipes RG, Thompson JL (2001) Glycine antagonist in neuroprotection for patients with acute stroke: GAIN Americas: a randomized controlled trial. JAMA 285:1719–1728CrossRefPubMedGoogle Scholar
  70. Sasaki O, Takeuchi S, Koizumi T, Koike T, Tanaka R (1996) Complete recanalization via fibrinolytic therapy can reduce the number of ischemic territories that progress to infarction. Am J Neuroradiol 17:1661–1668PubMedGoogle Scholar
  71. Saver JL, Johnston KC, Homer D, Wityk R, Koroshetz W, Truskowski LL, Haley EC (1999) Infarct volume as a surrogate or auxiliary outcome measure in ischemic stroke clinical trials. The RANTTAS Investigators. Stroke 30: 293–298CrossRefPubMedGoogle Scholar
  72. Schellinger PD, Jansen O, Fiebach JB, Heiland S, Steiner T, Schwab S, Pohlers O, Ryssel H, Sartor K, Hacke W (2000) Monitoring intravenous recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke with diffusion and perfusion MRI. Stroke 31: 1318–1328CrossRefPubMedGoogle Scholar
  73. Schmulling S, Grond M, Rudolf J, Heiss W-D (2000) One-year follow-up in acute stroke patients treated with rtPA in clinical routine. Stroke 31: 1552–1554CrossRefPubMedGoogle Scholar
  74. Schneweis S, Grond M, Staub F, Brinker G, Neveling M, Dohmen C, Graf R, Heiss W-D (2001) Predictive value of neurochemical monitoring in large middle cerebral artery infarction. Stroke 32: 1863–1867CrossRefPubMedGoogle Scholar
  75. Schulz JB, Weller M, Moskowitz MA (1999) Caspases as treatment targets in stroke and neurodegenerative diseases. Ann Neurol 45: 421–429CrossRefPubMedGoogle Scholar
  76. Schwab S, Schwarz S, Spranger M, Keller E, Bertram M, Hacke W (1998) Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke 29: 2461–2466CrossRefPubMedGoogle Scholar
  77. Segal AZ, Lev MH, Schwamm HL, Jeffery F, Jonathan R, Putman CM, Budzik RF, Hunter GJ, Rordorf G, Buonanno F, Koroshetz W, Gonzalez G (1999) CT-perfusion imaging in acute stroke with MCA stem occlusion: prediciting outcome after intraarterial (IA) thrombolysis. Stroke 30: 248Google Scholar
  78. Sherman DG, Atkinson RP, Chippendale T, Levin KA, Ng K, Futrell N, Hsu CY, Levy DE, for the STAT Participants (2000) Intravenous ancrod for treatment of acute ischemic stroke. The STAT study: a randomized controlled trial. JAMA-J Am Med Assoc 283: 2395–2403CrossRefGoogle Scholar
  79. Steiner T, Ringleb P, Hacke W (2001) Treatment options for large hemispheric stroke. Neurology 57 [Suppl 2]: S61–S68CrossRefPubMedGoogle Scholar
  80. Stroke Unit Trialists’ Collaboration (2001) Organised inpatient (stroke unit) care for stroke (Cochrane Review). The Cochrane Library 3Google Scholar
  81. Tanne D, Demchuk AM, Kasner SE, Grond M, Hanson SK, Hamilton S, Buchan AM, Wang DZ, Wechsler LR, Zweifler RM, Levine SR (2000) A large multinational investigation to predict t-PA related symptomatic ICH in patients with acute ischemic stroke. Stroke 30: 248Google Scholar
  82. The Ancrod Stroke Study Investigators (1994) Ancrod for the treatment of acute ischemic brain infarction. Stroke 25: 1755–1759CrossRefGoogle Scholar
  83. The European Ad Hoc Consensus Group (1996) European strategies for early internention in stroke. Cerebrovasc Dis 6: 315–324CrossRefGoogle Scholar
  84. The NINDS rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333: 1581–1587CrossRefGoogle Scholar
  85. Trouillas P, Nighoghossian N, Derex L, Adeleine P, Honnorat J, Neuschwander P, Riche G, Getenet JC, Li W, Froment JC, Turjman F, Malicier D, Fournier G, Gabry AL, Ledoux X, Berthezene Y, Ffrench P, Dechavanne M (1998) Thrombolysis with intravenous rtPA in a series of 100 cases of acute carotid territory stroke: determination of etiological, topographic, and radiological outcome factors. Stroke 29: 2529–2540CrossRefPubMedGoogle Scholar
  86. Ueda T, Sakaki S, Yuh WTC, Nochide I, Ohta S (1999) Outcome in acute stroke with successful intra-arterial thrombolysis and predictive value of initial single-photon emission-computed tomography. J Cereb Blood Flow Metab 19: 99–108CrossRefPubMedGoogle Scholar
  87. von Kummer R, Meyding-Lamade U, Forsting M, Rosin L, Rieke K, Hacke W, Sartor K (1994) Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk. AJNR Am J Neuroradiol 15: 9–15Google Scholar
  88. Wahlgren NG, Macmahon DG, De Keyser J, Indredavik B, Ryman T (1994) Intravenous nimodipine West-European Stroke Trial (INWEST) of nimodipine in the treatment of acute ischaemic stroke. Cerebrovasc Dis 4: 204–210CrossRefGoogle Scholar
  89. Wang DZ, Rose JA, Honings DS, Garwacki DJ, Milbrandt JC (2000) Treating acute stroke patients with intravenous tPA. The OSF stroke network experience. Stroke 31: 77–81CrossRefPubMedGoogle Scholar
  90. Wardlaw JM, Warlow CP, Counsell C (1997) Systematic review of evidence on thrombolytic therapy for acute ischemic stroke. Lancet 350: 607–614CrossRefPubMedGoogle Scholar
  91. Wardlaw JM, Del Zoppo G, Yamaguchi T (2000) Thrombolysis versus control in acute ischemic stroke (Cochrane Review). Cochrane Library 3Google Scholar
  92. Weir CJ, Murray GD, Dyker AG, Lees KR (1997) Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study. BMJ 314: 1303–1306CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2002

Authors and Affiliations

  • W.-D. Heiss
    • 1
  1. 1.Max-Planck-Institut für neurologische ForschungNeurologische UniversitätsklinikKölnFederal Republic of Germany

Personalised recommendations