Extension of fundamental stroke research into clinical care.

Clinical efforts in stroke prevention have measurably reduced the incidence of stroke in persons experiencing a number of risk factors. Clinical efforts to reduce stroke size once the process starts, however, have been disappointing. A variety of agents aimed at blocking the effects of excitotoxic neurotransmitters or interfering with intracellular calcium entry have been tested but with little success on clinical outcome. Satisfactory explanation of the paradox between animal and clinical outcome studies has not been forthcoming. Accordingly, clinical investigators are exploring the potential value of surgical craniectomy in efforts to improve the presently devastated outcome that marks the course of severe, large acute cerebral infarctions.