Safe, cheap, and broadly applicable therapies for acute stroke are urgently needed. Stroke ranks second as a cause of death worldwide and is the main cause of disability in high-income countries. In the Netherlands alone, more than 37.000 patients are admitted to hospital for acute stroke each year. As the incidence of stroke rises exponentially with age, the demographic change in world’s population will increase its socio-economic impact. Strokes are either ischemic or hemorrhagic. Treatment of ischemic stroke and intracerebral hemorrhage has remained unsatisfactory. Stroke unit care has been proven effective for all stroke patients, with an absolute risk reduction of death of 3% and longterm dependency of 5%.In patients with ischemic stroke, treatment with recombinant tissue-plasminogen activator (rt-PA) reduces the number of patients with poor outcome at three months by about 9%, but the short time window for administration (4.5 hours) and the associated bleeding risk restrict treatment with rt-PA to a minority of patients. Surgical decompression improves outcome in a very small selected group of patients aged up to 60 years who deteriorate because of space-occupying edema within 48 hours of stroke onset. Aspirin, started within 48 hours of symptom onset, is probably effective across the entire range of patients with ischemic stroke, but the benefit is small, with a number needed to treat of 79 to prevent death or dependency in a single patient.

Netherlands Heart Foundation,GlaxoSmithKline BV, Servier and Boehringer Ingelheim.
P.J. Koudstaal (Peter)
Erasmus University Rotterdam
Erasmus MC: University Medical Center Rotterdam

den Hertog, H. (2009, November 12). Body Temperature and Inflammation in Acute Stroke: implications for prognosis and treatment. Retrieved from