Purpose of review
This review highlights the progress achieved in stroke during the last year, and emphasizes recent controversies concerning its pathophysiology, therapy and secondary complications.
Studies published in 2004 provided new insights into the therapeutic window and ischemic penumbra, thrombolysis therapy, uncommon risk factors for stroke, and neuropsychological post-stroke complications. Despite the diffusion–perfusion mismatch remaining the most widely used technique to identify thresholds for ischemic penumbra and irreversible brain tissue damage, new imaging such as arterial spin-labeling perfusion and computed tomographic perfusion may define this impaired tissue more accurately. New studies assessed the relation of the interval from stroke onset to start intravenous thrombolysis treatment (tissue plasminogen activator) on favorable 3-month outcome, and on the occurrence of clinically relevant parenchymal hemorrhage: the benefit of tissue plasminogen activator could extend beyond 3 h, but with a few risks. Systemic inflammations and infections have been found to be associated with a substantial increase in the risk of developing vascular events, supporting the concept that systemic inflammation itself alters the probability of stroke occurrence. Recent literature concerning neuropsychological post-stroke complications focused mainly on the concept of mixed dementia and confirmed that mood disorders are common after stroke, and interfere with its long-term outcome.
Significant advances have been made during the last year in determining more accurately the therapeutic window, using new strategies and clinical markers. Moreover, new light has been thrown on less common stroke risk factors, and neuropsychological post-stroke complications.