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Personalising secondary prevention: different treatments for different strokes
  1. Hugh Markus
  1. Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
  1. Correspondence to Professor Hugh Markus, Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK; hsm32{at}


Stroke is a syndrome caused by many different disease mechanisms rather than being a single disease. It is important to identify the underlying mechanism accurately in individual patients in order to choose the best treatment approach. This article provides practical tips to diagnose the underlying subtype of stroke, and in particular discusses non-lacunar pathologies that can present with a clinical lacunar syndrome. It also reviews the recent advances in recurrent stroke prevention, including using more intensive antiplatelet regimens in the acute phase, and the concept that undetected cardiac arrhythmias may be important in apparently cryptogenic stroke.

  • stroke
  • diagnosis
  • secondary prevention
  • personalised medicine
  • lacunar stroke
  • anti-platelets
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  • Contributors HM wrote the review himself.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned. Externally peer reviewed by Peter Rothwell, Oxford, UK.

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