Diagnosis and Treatment of Cerebrovascular Attacks

Overview

CT of the brain is the first examination of patients with a cerebrovascular attack. In 15% ofpatients haemorrhage is revealed and further treatment is ensured by neurosurgical depart-ments. In ischaemic attacks in future thrombolytic treatment will be considered. Already in theacute stage it is important to rule be considered. Already in the acute stage it is important torule out embolism as the cause of a cerebrovascular attack. In patients with atrial fibrillationit will be useful to introduce miniheparinization and subsequent anticoagulant treatment(Warfarin with aimed INR 2-3). In patients with a sinus rhythm the authors supplement theexamination by transthoracic, and if possible, oesophageal echocardiography. During assess -ment of the source of embolization the same procedure is used as in patients with atrialfibrillation. In all patients sonography of the carotid circulation is made and patients witha significant stenosis are indicated for intervention.During hospitalization treatment is focused on prevention of complications as the risk ofpulmonary embolism and pneumonia is high in patients after a cerebrovascular attack. Viewsregarding vasoactive treatment are controversial and in future new neuroprotective drugs maybe foreseen. Early rehabilitation is of fundamental importance in patients with cerebrovascularattacks. The patient is discharged from hospital - depending on the etiology of the attack - withantiaggregation or anticoagulation treatment.

Key words:
cerebrovascular attacks - CT of the brain - echocardiography - sonography of the