Læknablaðið - 01.07.2014, Blaðsíða 33

LÆKNAblaðið 2014/100 401
ENGLISH SUMMARY
Four hundred individuals suffer from ischemic stroke every year in Ice-
land, more than one daily. Cerebral ischemia is an emergency. Around
two million brain cells die every minute after an occlusion of a cerebral
artery. Therefore, it is of utmost importance that the patient is transpor-
ted quickly to hospital, not least to receive thrombolytic treatment. Even
though thrombolytic treatment can be given up to four and a half hours
after the ictal event, time is brain and the effect of thombolysis reduces
dramatically as times passes. For every two patients who are treated
inside one hour, one recovers fully. When the treatment is administred
between three and four and a half hours only one in 14 recovers fully. All
patients with an acute stroke should be admitted to a stroke unit where
a multidisciplinary focus on stroke causation and treatment is present,
with emphasis on early rehabilitation. Secondary preventive treatment
focusing on anti-thrombotic, hypertensive, diabetic, cholesterol lowering
treatment, carotic endarterectomy and life style changes should be
initiated as soon as possible.
Cerebral ischemia/infarction - diagnosis and treatment
Olafur Arni Sveinsson1, Olafur Kjartansson2, Einar Mar Valdimarsson3
key words: cerebral ischemia, cerebral infarction, transient ischemic attack, Tissue plasminogen activator.
Correspondence: Olafur Sveinsson olafur.sveinsson@karolinska.se
1Department of Neurology Karolinska Hospital, Stockholm, Sweden, 2Department of Radiology, University Hospital of Iceland,3Department of neurology, University Hospital of Iceland,
Reykjavík, Iceland.
62. The Stroke Prevention by Aggressive Reduction in
Cholesterol Levels (SPARCL) Investigators High­dose
atorvastatin after stroke or transient ischemic attack. N
Engl J Med 2006; 355: 549­59.
63. Cholesterol Treatment Trialists’ (CTT) Collaborators
Efficacy and safety of cholesterol­lowering treatment: pro­
spective meta­analysis of data from 90,056 participants in
14 randomised trials of statins. Lancet 2005; 366: 1267­78.
64. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of
statins on low density lipoprotein cholesterol, ischaemic
heart disease, and stroke: systematic review and meta­
analysis. BMJ 2003; 326: 1423.
65. Graham DJ, Staffa JA, Shatin D, Andrade SE, Schech SD,
La Grenade L, et al. Incidence of hospitalized rhabdomyo­
lysis in patients treated with lipid­lowering drugs. JAMA
2004; 292: 2585­90.
66. Karapanayiotides T, Piechowski­Jozwiak B, van Melle G,
Bogousslavsky J, Devuyst G. Stroke patterns, etiology, and
prognosis in patients with diabetes mellitus. Neurology
2004; 62: 1558­62.
67. Intensive blood­glucose control with sulphonylureas or
insulin compared with conventional treatment and risk of
complications in patients with type 2 diabetes (UKPDS 33).
UK Prospective Diabetes Study (UKPDS). Group. Lancet
1998; 352: 837­53.
68. Effect of intensive blood­glucose control with metformin
on complications in overweight patients with type 2 diabe­
tes (UKPDS 34) UK Prospective Diabetes Study (UKPDS)
Group. Lancet 1998; 352: 854­65.
69. Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E,
Massi­Benedetti M, Moules IK, et al. Secondary prevention
of macrovascular events in patients with type 2 diabetes in
the PROactive Study (PROspective pioglitAzone Clinical
Trial In macroVascular Events): a randomised controlled
trial. Lancet 2005; 366: 1279­89.
70. Kawachi I, Colditz GA, Stampfer MJ, Willett WC, Manson
JE, Rosner B, Speizer FE, Hennekens CH. Smoking cessa­
tion and decreased risk of stroke in women. JAMA 1993;
269: 232­6.
71. Shinton R, Beevers G. Meta­analysis of relation between
cigarette smoking and stroke. BMJ 1989; 298: 789­94.
72. Wolf PA, D’Agostino RB, Kannel WB, Bonita R, Belanger
AJ. Cigarette smoking as a risk factor for stroke: the
Framingham Study. JAMA 1988; 259: 1025­9.
73. Aveyard P, West R. Managing smoking cessation. BMJ
2007; 335: 37­41.
74. Reynolds K, Lewis B, Nolen JD, Kinney GL, Sathya B, He
J. Alcohol consumption and risk of stroke: a meta­analysis.
JAMA 2003; 289: 579­88.
75. Brunner EJ, Thorogood M, Rees K, Hewitt G. Dietary
advice for reducing cardiovascular risk. Cochrane
Database Syst Rev 2005; (4) : CD002128.
76. FJ, MacGregor GA. Effect of longer­term modest salt
reduction on blood pressure. Cochrane Database Syst Rev
2004; (3): CD004937.
77. Tang JL, Armitage JM, Lancaster T, Silagy CA, Fowler GH,
Neil HA. Systematic review of dietary intervention trials
to lower blood total cholesterol in free­living subjects. BMJ
1998; 316: 1213­20.
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