nd Journal of Medicine on March 22, 1989, pages 861-68. As Daniel Singer, M.D., Director of Clinical Epidemiology in the General Medicine Unit with the Massachusetts General Hospital, and the epidemiologist on one of the ongoing warfarin trials says, "It is a premature extension of these findings to go ahead and recommend aspirin for everyone with atrial fibrillation, let alone for people with normal rhythm. The finding is surprising and so far is an isolated one." (Harvard Medical School Health Letter, 1990). As indicated, according to this study, the jury is still out on the usefulness of aspirin. However, this author is aware of the extent to which aspirin is regarded as not only a useful drug, but an important one and one that is utilized for stroke patients. At the same time, warfarin is also a subject of some debate and, as indicated, this usually rests with the study one refers to as well as the type of stroke and the population involved. There is one area where there remains little controversy or disagreement, however, and this has to do with prevention and early care particularly with acute stroke victims. Acute stroke can emanate from a wide variety of causes. The results of these may similarly run the gamut from arteriosclerosis and cardiac emboli to inflammatory conditions such as vasculitis, hemoglobinopathies such as Sickle Cell Anemia. For purposes of maximizing the extent of recovery and minimizing the likelihood of repeated stroke, the differential diagnosis must be accurate and the etiologic diagnosis as precise as possible. Current thinking among stroke experts holds that treatment should be directed at a patient's specific pathologic and pathophysiologic problems, not based only a time course or apparent extent of brain damage at early evaluation. Treatment based on time course when diagnosis is defined in such terms as partial stroke, stroke-in-progress, completed stroke, reversible ischemic neurologic deficit (RI...
