Acute stroke should be considered a medical emergency, where actions taken in the first hours are fundamental for achieving recovery of the damaged cerebral tissue and a better prognosis for the patient. Recanalization and neuroprotective treatment has been used with mixed results. The effectiveness observed in the first hours with thrombolytic drug treatment is only applicable to a small percentage of patients, and attempts to widen this treatment window have not yet proved fruitful. Pharmacological neuroprotective treatment has not yet demonstrated the clinical effectiveness observed in experimental models. The concept of neuroprotection in cerebral ischemia also involves a series of mechanisms that take place at the cerebral level following vascular occlusion. In this context, it should be borne in mind that a series of physiological functions usually involved in the cerebral metabolism (control of blood pressure, of temperature, of glycemia and of arterial oxygen saturation) play a key role in modulation of the ischemic process. Changes in the control of these mechanisms may aggravate the process of cerebral damage in the first hours of ischemic stroke. In this work we review the prognostic importance of the main mechanisms that may influence the acute phase of cerebral ischemic stroke, as well as their therapeutic management and control in the clinical situation.

Keywords:
Acute stroke, Non-pharmacological neuroprotection, Stroke, general care
1.
Wahlgren NG, Ahmed N: Neuroprotection in cerebral ischaemia: facts and fancies – the need for new approaches. Cerebrovasc Dis 2004;17(suppl 1):153–166.
2.
Davalos A, Castillo J, Alvarez-Sabin J, Secades JJ, Mercadal J, Lopez S, Cobo E, Warach S, Sherman D, Clark WM, Lozano R: Oral citicoline in acute ischemic stroke: an individual patient data pooling analysis of clinical trials. Stroke 2002;33:2850–2857.
3.
Lees KR, Zivin JA, Ashwood T et al: For the SAINT-1 Study Group. Preliminary results of the SAINT-1 Trial. 14th European Stroke Conference, Bologna, May 2005.
4.
The National Institutes of Neurological Disorders and Stroke rt-PA Stroke Study Group: Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–1587.
5.
Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Höxter G, Mahagne MH, Hennerici M, for the ECASS Study Group: Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study Group (ECASS). JAMA 1995;247:1017–1025.
6.
Hacke W, Kaste M, Fieschi C, von Kummer R, Dávalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Díez-Tejedor E, Trouillas P: Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 1998;352:1245–1251.
7.
Stroke Unit Trialist’s Collaboration: Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Review. Update Software, Issue 2. Oxford, The Cochrane Library, 2002.
8.
Busto R, Dietrich WD, Globos MY, Valdes I, Schierinberg P, Ginsberg MD: Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab 1987;7:729–738.
9.
Baron FC, Feuerstein GZ, White RF: Brain cooling during transient focal ischemia provides complete neuroprotection. Neurosci Biobehav Rev 1997;21:31–44.
10.
Onesti ST, Baker CJ, Sun PP, Solomon RA: Transient hypothermia reduces focal ischemic brain injury in the rat. Neurosurgery 1991;29:369–373.
11.
Zhang Y, Wong KC, Zhang Z: The effect of intraischemic mild hypothermia on focal cerebral ischemia/reperfusion injury. Acta Anaesthesiol Sin 2001;39:65–69.
12.
Colbourne F, Corbett D, Zhao Z, Yang J, Buchan AM: Prolonged but delayed postischemic hypothermia: a long-term outcome study in the rat middle cerebral artery occlusion model. J Cereb Blood Flow Metab 2000;20:1702–1708.
13.
Corbett D, Hamilton M, Colbourne F: Persistent neuroprotection with prolonged postischemic hypothermia in adult rats subjected to transient middle cerebral occlusion. Exp Neurol 2000;163:200–206.
14.
Kim Y, Busto R, Dietrich WD, Kraydieh S, Ginsberg MD: Delayed postischemic hyperthermia in awake rats worsens the histopathological outcome of transient focal cerebral ischemia. Stroke 1996;27:2274–2280.
15.
Cheng H, Chopp M, Welch KMA: Effect of mild hyperthermia on the ischemic infarct volume after middle cerebral artery occlusion in the rat. Neurology 1991;41:1133–1135.
16.
Baena RC, Busto R, Dietrich WD, Globus MY, Ginsberg MD: Hyperthermia delayed by 24 hours aggravates neuronal damage in rats hippocampus following global ischemia. Neurology 1997;48:768–773.
17.
Dietrich WD, Busto R, Valdes I, Loor Y: Effects of normothermic versus mild hyperthermic forebrain ischemia in rats. Stroke 1990;21:1318–1325.
18.
Olsen TS, Weber UJ, Kammersgaard LP: Therapeutic hypothermia for acute stroke. Lancet Neurol 2003;2:410–416.
19.
Huang ZG, Xue D, Preston E, Karbalai H, Buchan AM: Biphasic opening of the blood-brain barrier following transient focal ischemia: effects of hypothermia. Can J Neurol Sci 1999;26:298–304.
20.
Kumura E, Yoshimine T, Takaoka M, Hayakawa T, Shiga T, Kosaka H: Hypothermia suppresses nitric oxide elevation during reperfusion after focal cerebral ischemia in rats. Neurosci Lett 1996;220:45–48.
21.
Takagi K, Ginsberg MD, Globus MY, Dietrich WD, Martinez E, Kraydieh S, Busto R: Changes in amino acid neurotransmitters and cerebral blood flow in the ischemic penumbral region following middle cerebral artery occlusion in the rat: correlation with histopathology. J Cereb Blood Flow Metab 1993;13:575–585.
22.
Nakashima K, Todd MM: Effects of hypothermia on the rate of excitatory amino acid release after ischemic depolarization. Stroke 1996;27:913–918.
23.
Eguchi Y, Yamashita K, Iwamoto T, Ito H: Effects of brain temperature on calmodulin and microtubule-associated protein 2 immunoreactivity in the gerbil hippocampus following transient forebrain ischemia. J Neurotrauma 1997;14:109–118.
24.
Ishikawa M, Sekizuka E, Yamaguchi SS et al: Effects of moderate hypothermia on leukocyte-endothelium interaction in the rat pial microvasculature after transient middle cerebral artery occlusion. Stroke 1999;30:1679–1686.
25.
Hindfelt B: The prognostic significance of subfebrility and fever in ischemic cerebral infarction. Acta Neurol Scand 1976;53:72–79.
26.
Terent A, Anderson B: The prognosis for patients with cerebrovascular stroke and transient ischemic attacks. Ups J Med Sci 1981;86:63–74.
27.
Castillo J, Martinez F, Leira R, Prieto JM, Lema M, Noya M: Mortality and morbidity of acute cerebral infarction related to temperature and basal analytic parameters. Cerebrovasc Dis 1994;4:66–71.
28.
Azzimondi G, Bassein L, Nonino F, Montagutiu U, Celin D, Re G, D’Alessandro R: Fever in acute stroke worsens prognosis: a prospective study. Stroke 1995;26:2040–2043.
29.
Reith J, Jorgensen HS, Pedersen PM, Nakayama H, Raaschou HO, Jeppensen L, Olsen TS: Body temperature in acute stroke: relation to stroke severity, infarct size, mortality and outcome. Lancet 1996;347:422–425.
30.
Davalos A, Castillo J, Pumar JM, Noya M: Body temperature and fibrinogen are related to early neurological deterioration in acute ischemic stroke. Cerebrovasc Dis 1997;7:64–69.
31.
Castillo J, Dávalos A, Marrugat J, Noya M: Timing for fever-related brain damage in acute ischemic stroke. Stroke 1998;29:2455–2460.
32.
Indredavik B, Bakke F, Slordahl SA, Roseth R, Haheim LL: Treatment in a combined acute and rehabilitation stroke unit. Which aspects are most important? Stroke 1999;30:917–923.
33.
Wang Y, Lim LL, Levi C, Heller RF, Fisher J: Influence of admission body temperature on stroke mortality. Stroke 2000;31:404–409.
34.
Szczudlik A, Turaj W, Slowik A, Stronjny J: Microalbuminuria and hyperthermia independently predict long-term mortality in acute ischemic stroke patients. Acta Neurol Scand 2003;107:96–101.
35.
Hajat C, Hajat S, Shaarma P: Effects of poststroke pyrexia on stroke outcome: a meta-analysis of studies in patients. Stroke 2000;31:410–414.
36.
Kammersgaard LP, Jorgensen HS, Rungby JA, Reith J, Nakayama H, Weber UJ, Houth J, Olsen TS: Admission body temperature predicts long-term mortality after acute stroke. Stroke 2002;33:1759–1762.
37.
Boysen G, Christensen H: Stroke severity determines body temperature in acute stroke. Stroke 2001;32:413–417.
38.
Dippel DWJ, van Breda EJ, van Germet HMA, van der Worp HB, Meijer RJ, Kappelle LJ, Koudstaal PJ, on behalf of the PAPAS Investigators: Effect of paracetamol (acetaminophen) on body temperature in acute ischemic stroke. A double-blind, randomized phase II clinical trial. Stroke 2001;32:1607–1612.
39.
Kasner SE, Wein T, Piriyawat P, Villar-Cordova CE, Cálela JA, Krieg DW, Morgenstern LB, Kimmel SE, Grotta JC: Acetaminophen for altering body temperature in acute stroke: a randomized clinical trial. Stroke 2002;33:130–134.
40.
Koennecke HC, Leistner S: Prophylactic antipyretic treatment with acetaminophen in acute ischemic stroke: a pilot study. Neurology 2001;57:2301–2303.
41.
Naritomi H, Shimizu T, Oe H, Kinugawa H, Sawada T, Hirata T: Mild hypothermia is effective for the treatment of acute embolic stroke if induced within 24 hours after onset but not the later phase. J Stroke Cerebrovasc Dis 1996;6(suppl 1):193–196.
42.
Schwab S, Schwarz S, Spranger M, Keller E, Bertram M, Hacke W: Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke 1998;29:2461–2466.
43.
Georgiadis D, Schwarz S, Kollmar R, Schwab S: Endovascular cooling for moderate hypothermia in patients with acute stroke: first results of a novel approach. Stroke 2001;32:2550–2553.
44.
Krieger DW, De Georgia MA, Abou-Chebl A, Andrefsky JC, Sila CA, Katzan IL, Mayberg MR, Furlan AJ: Cooling for acute ischemic brain damage (cool aid): an open pilot study of induced hypothermia in acute ischemic stroke. Stroke 2001;32:1847–1854.
45.
Schwab S, Georgiadis D, Berrouschot J, Schellinger PD, Graffagnimo C, Mayer S: Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke 2001;32:2033–2035.
46.
Kammersgaard LP, Rasmussen BH, Jorgensen HS, Reith J, Weber U, Olsen TS: Feasibility and safety of inducing modest hypothermia in awake patients with acute stroke through surface cooling, a case-control study: the Copenhagen Stroke Study. Stroke 2000;31:2251–2256.
47.
Correia M, Silva M, Veloso M: Cooling therapy for acute stroke (Cochrane Review). Update Software. Oxford, The Cochrane Library, 2003.
48.
Scott JF, Robinson GM, French JM, O’Connell JE, Alberti KGMM, Gray CS: Prevalence of admission hyperglycaemia across clinical subtypes of acute stroke. Lancet 1999;353:376–377.
49.
Kiers L, Davis SM, Larkins R, Hopper J, Tres B, Rossiter SC, Carlin J, Ratnaike S: Stroke topography and outcome in relation to hyperglycaemia and diabetes. J Neurol Neurosurg Psychiatry 1992;5:263–270.
50.
Woo J, Lam CWK, Kay R, Wong HAY, Teoh R, Nicholla MG: The influence of hyperglycaemia and diabetes mellitus on immediate and 3-month morbidity and mortality after acute stroke. Arch Neurol 1990;47:1174–1177.
51.
Yip PK, He YY, Hsu CY, Garg N, Marangos P, Hogen EL: Effect of plasma glucose on infarct size in focal cerebral ischemia-reperfusion. Neurology 1991;41:899–905.
52.
Prado R, Ginsberg MD, Dietrich WD, Watson BD, Busto R: Hyperglycemia increases infarct size in collaterally perfused but not end-arterial vascular territories. J Cereb Blood Flow Metab 1988;8:186–192.
53.
Anderson RE, Tan WK, Martin HS, Meyers FB: Effects of glucose and PO2 modulation on cortical intracellular acidosis, NADH redox state, and infarction in the ischemic penumbra. Stroke 1999;30:160–170.
54.
Linsberg PJ, Roine RO: Hyperglycemia in acute stroke. Stroke 2004;35:363–364.
55.
De Courtten-Meyers G, Myers RE, Schoolfield L: Hyperglycemia enlarges infarct size in cerebrovascular occlusion in cats. Stroke 1988;19:623–630.
56.
Kawai N, Keep RF, Benz AL: Hyperglycemia and the vascular effects of cerebral ischemia. Stroke 1997;28:149–154.
57.
Hamilton MG, Tranmer BI, Aver RN: Insulin reduction of cerebral infarction due to transient focal ischemia. J Neurosug 1995;82:262–268.
58.
Weir JC, Murria GD, Dyker AG, Lees KR: Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow-up study. BMJ 1997;314:1303–1306.
59.
Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS: Stroke in patients with diabetes: the Copenhagen Stroke Study. Stroke 1994;25:1977–1984.
60.
Bruno A, Biller J, Adams HP, Clarke WR, Woolson RF, Williams LS, Hansen MD, for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology 1999;52:280–284.
61.
Capes SE, Hunt D, Malmberg K, Pathak P, Gerstein HC: Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001;32:2426–2432.
62.
Tracey F, Stout RW: Hyperglycemia in the acute phase of stroke and stress response. Stroke 1994;25:524–525.
63.
Counsell C, McDowall M, Dennis M: Hyperglycemia after acute stroke. Other models find that hyperglycemia is not independent predictor. BMJ 1997;315:810–811.
64.
Christensen H, Boysen G: Blood glucose increases early after stroke onset: a study on serial measurements of blood glucose in acute stroke. Eur J Neurol 2002;9:297–301.
65.
Gray CS, Hildreth AJ, Alberti GKMM, O’Connell JE, on behalf of the GIST Collaboration: Post-stroke hyperglycemia: natural history and immediate management. Stroke 2004;35:122–126.
66.
Baird TA, Parsons MW, Phanh T, Butcher KS, Desmond PM, Tress BM, Colman PG, Chambers BR, Davis SM: Persistent post-stroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke 2003;34:2208–2214.
67.
Alvarez Sabín J, Molina CA, Montaner J, Arenillas JF, Huertas R, Ribo M, Codina A, Quintana M: Effects of admission hyperglycaemia on stroke outcome in reperfused tissue plasminogen activator-treated patients. Stroke 2003:34:1235–1241.
68.
Kagansky N, Levy S, Knobler H: The role of hyperglycemia in acute stroke. Arch Neurol 2001;58:1209–1212.
69.
Klijn CJM, Hankey GJ: Management of acute ischemic stroke: new guidelines from the American Stroke Association and European Stroke Initiative. Lancet Neurol 2003;2:698–701.
70.
Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359–1367.
71.
Scott JF, Robinson GM, French JM, O’Connell JE, Alberti KGMM, Gray CS: Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia. The Glucose Insulin in Stroke Trial (GIST). Stroke 1999;30:793–799.
72.
European Stroke Initiative (EUSI), on behalf of the European Stroke Council (ESC), The European Neurological Society (ENS), the European Federation of Neurological Societies (EFNS): Recommendations for stroke management. Cerebrovasc Dis 2000;10(suppl 3):1–34.
73.
Díez Tejedor E, Fuentes B, Dávalos A, Gil Nuñez A, Vila N, Vivancos J, Egido J, Castillo J, Mostacero E: Glucose levels in acute stroke: The GLIA Study. Preliminary analysis on 250 patients. Cerebrovasc Dis 2004;17(suppl 5):2.
74.
Wass CT, Lainer WL: Glucose modulation of ischemic brain injury: review and clinical recommendations. Mayo Clin Proc 1996;71:801–812.
75.
Díez-Tejedor E, Fuentes B: Acute care in stroke units: the importance of early intervention to achieve better brain neuroprotection. Cerebrovasc Dis 2004;17(suppl 1):130–137.
76.
Powers WJ: Acute hypertension after stroke: the scientific basis for treatment decisions. Neurology 1993;43:461–467.
77.
Vemmos KN, Tsivgoulis G, Spengos K, Zakopoulos N, Synetos A: U-shaped relationship between mortality and admission blood pressure in patients with acute stroke. J Intern Med 2004;255:257–265.
78.
Leonardi-Bee J, Bath PM, Philips SJ, Sandercock PA, IST Collaborative Group: Blood pressure and clinical outcomes in the International Stroke Trial. Stroke 2002;33;1315–1320.
79.
Castillo J, Leira R, García MM, Serena J, Blanco M, Dávalos A: Blood pressure decrease during the acute phase of ischemic stroke is associated with brain injury and poor stroke outcome. Stroke 2004;35:520–527.
80.
Oliveira-Filho J, Silva SCS, Trabuco CC, Pedreira BB, Sousa EU, Bacellar A: Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset. Neurology 2003;61:1047–1051.
81.
Grossman E, Messerli FH, Grodzicki T, Kowey P: Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA 1996;276:1328–1331.
82.
Ahmed N, Näsman P, Wahgren NG: Effect of intravenous nimodipine on blood pressure and outcome after acute stroke. Stroke 2000;131:1250–1255.
83.
Carlberg B, Asplund K, Hägg E: The prognostic value of admission blood pressure in patients with acute stroke. Stroke 1993;24:1372–1375.
84.
Robinson TG, Dawson SL, Ahmed U, Manktelow B, Fotherby MD, Potter JF: Twenty-four hour systolic blood pressure predicts long-term mortality following acute stroke. J Hypertens 2001;19:2127–2134.
85.
Lawes CM, Bennett DA, Feigin VL, Rodgers A: Blood pressure and stroke: a overview of published reviews. Stroke 2004;35:776–785.
86.
Willmot M, Leonardo-Bee J, Bath PMW: High blood pressure in acute stroke and subsequent outcome. A systematic review. Hypertension 2004;43:18–24.
87.
Jorgensen HS, Nakayama H, Christensen HR, Raaschou HO, Kampmann JP, Olsen TS: Blood pressure in acute stroke. The Copenhagen Stroke Study. Cerebrovasc Dis 2002;13:204–209.
88.
Chamorro A, Vila N, Ascaso C, Elices E, Schonewille W, Blanc R: Blood pressure and functional recovery in acute ischemic stroke. Stroke 1998;29:1850–1853.
89.
Allen CMC: Predicting the outcome of acute stroke: a prognosis score. J Neurol Neurosurg Psychiatry 1984;47:475–480.
90.
Lindenauer PK, Mathew MC, Ntuli TS, Pekow PS, Fitzgerald J, Benjamin EM: Use of antihypertensive agents in the management of patients with acute stroke. Neurology 2004;63:318–323.
91.
Yatsu FM, Zivin J: Hypertension in acute ischemic stroke: not to treat. Arch Neurol 1985;42:999–1000.
92.
Spence JD, Del Maestro RF: Hypertension in acute ischemic stroke: treat. Arch Neurol 1985;42:1000–1002.
93.
Broderick J, Brott T, Barsan W, Haley EC, Levy D, Marler J, Sheppard G, Blum C: Blood pressure during the first minutes of focal cerebral ischemia. Ann Emerg Med 1993;22:1438–1443.
94.
Mattle HP, Kappeler L, Arnold M, Fisher V, Nedeltchev K, Remonda L, Jakob SM, Schroth G: Blood pressure and vessel recanalization in the first hours after ischemic stroke. Stroke 2005;36:264–269.
95.
Adams HP Jr, Adams RJ, Brott TG, del Zoppo GJ, Furlan A, Goldstein LB, Grubb RL, Higashida R, Kidwell C, Kwiatkowski TG, Marler JR, Hademenos GJ; for the Stroke Council of the American Stroke Association: Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke Council of the American Stroke Association. Stroke 2003;34:1056–1083.
96.
The NINDS t-PA Stroke Study Group: Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. Stroke 1997;28:2109–2118.
97.
Larrue V, von Kummer R, del Zoppo G, Bluhmki E: Hemorrhagic transformation in acute ischemic stroke: potential contributing factors in the European Cooperative Acute Stroke Study. Stroke 1997;28:957–960.
98.
Bath P: High blood pressure as risk factor and prognostic predictor in acute ischaemic stroke: when and how to treat it? Cerebrovasc Dis 2004;17(suppl 1):51–57.
99.
Wahlgren NG, MacMahon DG, De Keyser J, Indredavik B, Ryman T for the INWest Study Group: Intravenous Nimodipine West European Stroke Trial (INWEST) of nimodipine in the treatment of acute ischemic stroke. Cerebrovasc Dis 1994;4:204–210.
100.
Kaste M, Fogelholm R, Erilä T, Palomäki H, Murros K, Rissanen A, Sarna S: A randomized, double-blind, placebo-controlled trial of nimodipine in acute ischemic hemispheric stroke. Stroke 1994;25:1348–1353.
101.
Dyker AG, Grosset DG, Lees K: Perindopril reduces blood pressure but not cerebral blood flow in patients with recent cerebral ischemic stroke. Stroke 1997;28:580–583.
102.
Schrader J, Lüders S, Kulschewski A, Berger J, Zidek W, Treib J, Einhäupl K, Diener HC, Dominiak P, on behalf of the ACCESS Study Group: The ACCESS Study. Evaluation of acute candesartan cilexetil therapy in stroke survivors. Stroke 2003;34:1699–1703.
103.
Blood Pressure in Acute Stroke Collaboration (BASC): Intervention for deliberately altering blood pressure in acute stroke. Update Software, Issue 3. Oxford, The Cochrane Library, 2003.
104.
Ronning OM, Guldvog B: Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial. Stroke 1999;29:779–784.
105.
Strandt T: Evaluation of long-term outcome and safety after hemodilution therapy in acute ischemic stroke. Stroke 1992;23:657–662.
106.
Hemodilution in Stroke Study Group: Hypervolemic hemodilution in acute stroke: a randomized multicenter trial using pentastarch. Stroke 1989;20:317–323.
107.
Asplund K: Hemodilution for acute ischemic stroke. Cochrane Database Syst Rev 2002;4:CD000103.
108.
Alvarez-Sabin J, Molina C, Montaner J, Arenillas J, Pujadas F, Huertas R, Mouriño J, Rubio M, Santamaria E, Quintana M: Clinical benefit following the implementation of a specialized urgent care system. Med Clin (Barc) 2004;122:528–531.
109.
Indredavik B, Bakke F, Solberg R, Rokseth R, Haheim LL, Holme I: Benefit of a stroke unit: a randomized controlled trial. Stroke 1991;22:1026–1031.
110.
Langhorne P, Williams BO, Gilchirst W, Howie K: Do stroke units save lives? Lancet 1993;342:395–398.
111.
Stroke Unit Trialist’s Collaboration: How do stroke units improve patient outcomes? Stroke 1007;28:2139–2144.
112.
Diez-Tejedor E, Fuentes B: Acute care in stroke: do stroke units make the difference? Cerebrovasc Dis 2001(suppl 1):31–39.
113.
Langhorne P, Tong BL, Stott DJ: Association between physiological homeostasis and early recovery after stroke. Stroke 2000;31:2518–2519.
© 2006 S. Karger AG, Basel
2006
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.