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Læknablaðið - 01.07.2014, Page 33

Læknablaðið - 01.07.2014, Page 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. Y F I R L I T

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