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Clinical radiologic correlations in acute stroke: is the signal intensity at the end of the tunnel getting brighter quicker?
  1. D M Brown,
  2. S R Levine
  1. Stroke Program, Department of Neurology, The Mount Sinai School of Medicine, New York, NY 10029–6574, USA
  1. Correspondence to:
 S R Levine, Stroke Program, Department of Neurology, Box 1137, The Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029–6574, USA; 
 steven.levine{at}mssm.edu

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Is time to clot lysis the key factor predicting outcome after focal cerebral ischaemia?

Current practice relies on time dependent criteria for decisions regarding acute stroke therapy. This is based on the results of the NINDS rt-PA Stroke Trial,1–2 animal,3 and other clinical studies4 that indicate that time to clot lysis is the key factor predicting outcome after focal cerebral ischaemia. We know that every patient at the same time from symptom onset of ischaemic stroke does not benefit equally from acute therapies. Factors other than time, such as collateral circulation, stroke aetiology, permanent versus intermittent occlusive process, coagulation state, age, underlying disease state (eg diabetes mellitus, hypertension, haematocrit), sex, and other genetic factors, are likely to influence response to thrombolysis and other acute therapies.5 Current investigations are seeking alternate protocols, biological markers, and criteria for acute therapy, some of which are based on imaging of …

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