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Neurological emergencies: acute stroke
  1. A RABINSTEIN
  1. Department of Neurology, University of Miami School of Medicine, 1501 NW 9 Avenue, Miami, FL 33136, USA

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    We greatly enjoyed reading the recently published review on acute stroke by Davenport and Dennis.1 Their didactic approach and strict compromise to distinguishing between evidence based approaches and their personal beliefs deserve compliment. We would like to contribute by clarifying some information on two topics.

    Firstly, the authors make a brief comment on the use of anticoagulants in the treatment of cerebral venous thrombosis (CVT) indicating that a recent randomised trial showed a non-significant favourable effect.2 This may lead to a misinterpretation. Most experts currently agree that anticoagulation should be used in the acute treatment of CVT based on the available evidence. In 1991, Einhaulp et al 3 published the results of their randomised double blind prospective study comparing heparin and placebo. This study was prematurely interrupted after enrolling 20 patients because of the dramatic differences noted in outcome in favour of the heparin group (basically eight patients recovered fully and no deaths occurred in the heparin arm whereas only one patient recovered completely and three others died in the …

    Dr R J Davenport rjd{at}skull.dcn.ed.ac.uk

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