The clinical manifestations and the main aetiological factors of cerebrovascular disease in the elderly are discussed excluding primary subarachnoid haemorrhage and the effects of trauma. The five common syndromes of transient cerebral ischaemic attacks, minor strokes, progressing major strokes, completed major strokes, and the chronic brain syndrome are described and recommendations made for their investigation and general management. Pharmacotherapy is considered separately and the author's views on anticoagulants, anti-platelet aggregating drugs, cerebral vasodilators, hypotensive therapy, steroids and the use of psychotropic drugs are explained, together with evidence from other sources as to their effectiveness. The importance of hypertension as the main factor in stroke production is stressed.
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