This article represents the update of the European Stroke Initiative Recommendations for Stroke Management. These guidelines cover both ischaemic stroke and transient ischaemic attacks, which are now considered to be a single entity. The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation.

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Abstract-Aortic stiffness predicts an excess risk of stroke, supposedly via cerebral small-vessel disease. White matter hyperintensities, silent lacunar infarcts, and brain microbleeds, manifestations of cerebral small-vessel disease on neuroimaging, may precede overt cerebrovascular disease. Therefore, we assessed whether aortic stiffness is also related to such lesions. In 167 hypertensive patients (85 men) without a history of cardiovascular or cerebrovascular disease, a mean age of 51.8Ϯ13.1 years, and untreated office blood pressure levels of 169Ϯ25/104Ϯ12 mm Hg, we determined aortic pulse wave velocity and office and ambulatory 24-hour pulse pressure (off medication), as well as the volume of white matter hyperintensities and the presence of lacunar infarcts and microbleeds using brain MRI. Linear and logistic regression analyses were performed to assess the relationships between the arterial stiffness measures and brain lesions. Aortic stiffness and pulse pressure were significantly related to each of the brain lesions in univariate analyses (PϽ0.05). Multivariate analyses, adjusted for age, sex, brain volume, mean arterial pressure, and heart rate, showed that a higher pulse wave velocity was significantly associated with a greater volume of white matter hyperintensities (unstandardized regression coefficient: 0. Key Words: aortic stiffness Ⅲ pulse wave velocity Ⅲ pulse pressure Ⅲ cerebral small-vessel disease Ⅲ brain Ⅲ hypertension T he arterial system gradually stiffens because of the shared effects of ageing, high blood pressure (BP), and other vascular risk factors. 1 Arterial stiffness can be assessed by noninvasive pulse wave velocity (PWV) measurements. 2 In particular, the velocity of the carotidfemoral or aortic pulse wave appears to be of prognostic importance and is considered to be the "gold standard" for arterial stiffness. 3 Several studies, in both population-and patient-based cohorts, have demonstrated a strong association between increased aortic PWV and excess risk of cardiovascular complications, including stroke. 4 -6 Whether the risk of stroke is mediated by large-and/or small-vessel disease is not clear, but the previously reported increased risk of stroke in the presence of preclinical cerebral microvascular disease, ie, white matter hyperintensities (WMHs), silent lacunar infarcts (LACs), and/or brain microbleeds (BMBs), suggests small-vessel disease involvement. 7,8 O'Rourke and Safar 9 hypothesized that cerebral microvascular disease results from the damaging forces of abnormal flow pulsations extending into small cerebral arteries as a consequence of arterial stiffening. However, the relationship between arterial stiffness and manifestations of cerebral small-vessel disease has not been investigated in great detail, and studies have yielded conflicting results. 10 -12 The present study was undertaken to assess the associations between aortic PWV and WMHs, LACs, and BMBs as manifestations of silent cerebral small-vessel disease on MRI of the brain in a cohort of hypertensiv...

Background and Purpose-Treatment of intracerebral hematoma (ICH) is controversial. An advantage of neurosurgical intervention over conservative treatment of ICH has not been established. Recent reports suggest a favorable effect of stereotactic blood clot removal after liquefaction by means of a plasminogen activator. The SICHPA trial was aimed at investigating the efficacy of this treatment. Methods-A stereotactically placed catheter was used to instill urokinase to liquefy and drain the ICH in 6-hour intervals over 48 hours. From 1996 to 1999, 13 centers entered 71 patients into the study. Patients were randomized into a surgical group (nϭ36) and a nonsurgical group (nϭ35). Admission criteria were the following: age Ͼ45 years, spontaneous supratentorial ICH, Glasgow Eye Motor score ranging from 2 to 10, ICH volume Ͼ10 cm 3 , and treatment within 72 hours. The primary end point was death at 6 months. As secondary end points, ICH volume reduction and overall outcome measured by the modified Rankin scale were chosen. The trial was prematurely stopped as a result of slow patient accrual. Results-Seventy patients were analyzed. Overall mortality at day 180 after stroke was 57%; this included 20 of 36 patients (56%) in the surgical group and 20 of 34 patients (59%) in the nonsurgical group. A significant ICH volume reduction was achieved by the intervention (10% to 20%, PϽ0.05). Logistic regression analysis indicated the possibility of efficacy for surgical treatment (odds ratio, 0.23; 95% confidence interval, 0.05 to 1.20; Pϭ0.08). The odds ratio of mortality combined with modified Rankin scale score 5 at 180 days was also not statistically significant (odds ratio, 0.52; 95% confidence interval, 1.2 to 2.3; Pϭ0.38). Conclusions-Stereotactic aspiration can be performed safely and in a relatively uniform manner; it leads to a modest reduction of 18 mL of hematoma reduction over 7 days when compared with control, which has a 7-mL reduction, and therefore may improve prognosis.