Stroke and TIA. Prevention and management of cerebrovascular events in primary care.

Stroke is a major cause of death and disability in the United States. Control of risk factors--particularly hypertension, diabetes, elevated serum lipids, and atrial fibrillation--can significantly reduce the incidence of stroke. Platelet antiaggregant therapy has a role in primary and secondary stroke prevention. Patients with transient ischemic attacks presenting with carotid stenosis > 70% can be managed surgically, whereas those with less stenosis can be treated with platelet antiaggregant therapy. Acute stroke is a medical emergency. Thrombolytic therapy with tissue plasminogen activator within 3 hours of event onset can significantly improve outcomes in selected ischemic stroke patients. Patients with intracerebral hemorrhage usually present with acute onset of identifiable neurologic deficits.