Overview of trends in management and prognosis of stroke.

Prevention is the ideal treatment for stroke, and the major decline in stroke mortality is most likely related to treatment of risk factors. Even when a vascular insult to the brain has occurred, an important treatment effect is the prevention of additional future events. No specific therapy for asymptomatic lesions has yet been proved to be effective. For patients with transient ischemia or mild stroke with functional recovery, the risk of additional strokes and death can be decreased by platelet-antiaggregating agents and carotid endarterectomy, which is effective in patients with greater than 70% stenosis of a symptomatic artery. Once a major stroke has occurred, the goals of therapy include prevention of disease progression, minimization of the permanent damage by the lesion, and prevention of new events. In addition to preventive therapies, several acute intervention therapies may be effective in reducing morbidity and mortality following stroke. While there are many similarities in cardiovascular and cerebrovascular disease, important differences appear to exist.