Cerebrovascular Disease: Experience Within Large Multicentre Trials

Abstract

Stroke is defined as rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 h or longer or leading to earlier death, with no apparent cause other than of vascular origin. Transient ischaemic attack (TIA) is defined identically except that the symptoms and signs resolve within 24h [1]. There is no fundamental difference between a TIA and a stroke except for the duration. Stroke is therefore a syndrome with numerous symptoms and signs; it has different aetiologies and the prognosis can vary enormously. Disability may be considered by some to be a worse outcome than death since stroke can affect every aspect of normal life, from higher mental functions such as intelligence, personality and expression to more mundane tasks such as toileting, dressing and feeding. The extremely wide definition of stroke and the enormous variety of outcomes has made the conduct of clinical trials in stroke and the choice of outcome measures problematic. In spite of this, there is more information available from clinical trials to facilitate evidence-based practice in stroke than in any other neurological discipline. In this chapter, we discuss the major issues, problems and solutions derived from the most important multicentre trials of cerebrovascular disease.