Viewpoint in 2009

The use of intravenous recombinant tissue plasminogen activator to treat acute ischemic stroke has been limited by the need to administer the treatment within 3 hours of symptom onset, although recent findings indicate that this therapeutic window can be extended to 4.5 hours. In this Viewpoint, Maulaz et al. argue that the safety and efficacy of thrombolysis might be further improved by narrowing the selection criteria for this therapy.

Many issues surround the treatment of patients with idiopathic normal pressure hydrocephalus by use of shunting. In this Viewpoint, Sachin Batra and Daniele Rigamonti advise on how to achieve the best results with this procedure—including use of appropriate patient selection methods, and accurate monitoring after surgery. They believe that many patients can have good outcomes from shunting but urge physicians to actively work to maintain high standards.

What is the duty of care owed by neurologists to the 'man on the street'? Does the ethical imperative to treat exist only in a medical emergency or after the establishment of a formal doctor–patient relationship? In this Viewpoint, Lim et al. draw on their personal experiences to explore these important questions.