Attitudes in the management of acute ischaemic cere-brovascular accident and cerebral haemorrhage in Latin America: a multinational study

Abstract

ABSTRACT— Eleven neurologists (the Collaborative Group) from 7 Latin American countries interviewed 73 of their peers (respondents) with a questionnaire containing points on history-taking, investigations performed, and treatment. The obvious methodological pitfalls of this method are discussed. It was felt, nevertheless, that with judicious interpretation of the answers a fair reflection of reality can be obtained. Items in the history which are less frequently enquired for were alcohol intake just before a stroke, known abnormalities in the blood picture, and intermittent claudication. Amongst less frequently performed investigations were Doppler study of carotids, angiography, lumbar puncture, echocardiography ordered without the indication of a cardiologist, and EEG. Regarding treatment, steroids were preferred by a large majority in the treatment of cerebral oedema. In other items two thirds or more of respondents reached agreement except when dealing with high blood pressure on admission, the use of aspirin in acute ischaemic non-cardiogenic stroke and the use of anticoagulants in stroke considered to be progressing. No differences by country or years of experience were found. The management of affluent and poorer patients was more even than might be expected, most telling differences being CT scanning and anticoagulation.