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Current nationwide promotion for emergency treatment of an acute stroke called brain attack puts every general hospital in jeopardy if it does not respond appropriately to an emergency. The extensive publicity campaign to promote thrombolytic therapy within 3 hours of stroke onset has found many hospitals totally unprepared. This lack of preparation deserves intensive consideration and possible tempering of the message, but advances in stroke therapy, particularly by thrombolysis and neuroprotective agents, should have propelled the profession beyond its therapeutic nihilism. Nonetheless, that nihilism persists and is supported by fear that thrombolytic drugs may produce cerebral hemorrhage and possibly malpractice suits, a possibility that today is not prevented by withholding thrombolytic therapy. Actually, malpractice suits are more likely to result from the failure to provide thrombolytic therapy (P. B. Gorelick, MD, oral communication, July 1999).

Although 45% of patients in some cities arrive at the emergency department within less than . . . [Full Text of this Article]