"Stroke and struck": protecting the brain from cerebrovascular disease. .Stroke is a severe, expensive, and common disorder. As Dr. Caplan (1) points out in his editorial in this special Stroke Continuing Medical Education continuing medical education See CME. (CME CME See: Chicago Mercantile Exchange CME See Chicago Mercantile Exchange (CME). ) issue of Southern Medical Journal, the patient's life is never the same after a major disabling stroke, because of the loss of vocational, personal, and financial independence. During the past decade, which coincides with the Decade of the Brain, clinicians who treat stroke patients have gone from therapeutic pessimism to activism in cerebrovascular cer·e·bro·vas·cu·lar adj. Relating to the blood supply to the brain, particularly with reference to pathological changes. cerebrovascular pertaining to the blood vessels of the cerebrum or brain. management. Neurologists have achieved the primary role in cerebrovascular management, and other physicians need to know that they can depend on neurologists for acute stroke management, such that there is a knee-jerk reaction--whether stroke occurs in the emergency room or in the intensive care unit--of calling the neurologist. In referring mild myocardial infarction myocardial infarction: see under infarction. patients for treatment, 90% of primary care physicians refer to a cardiologist, but only 30% refer mild stroke patients to the neurologist. Neuro logists must educate other physicians and the public regarding stroke diagnostic and therapeutic strategies to achieve vascular protection and neuroprotection to minimize damage to the brain. This will allow the development of active strategies to treat stroke and prevent the brain's being ravaged rav·age v. rav·aged, rav·ag·ing, rav·ages v.tr. 1. To bring heavy destruction on; devastate: A tornado ravaged the town. 2. by the effects of ischemia (ie, "struck"). In assessing cerebrovascular disease cerebrovascular disease Neurology Any vascular disease affecting cerebral arteries–eg ASHD, diabetic vasculopathy, HTN, which may cause a CVA or TIA with neurologic sequelae–speech, vision, movement of variable duration. , remember the Virchow triad and the risk of vascular occlusion: abnormality of blood vessel wall, abnormality of the pump (cardiac disorders), abnormalities of the coagulation coagulation (kōăg'y  lā`shən), the collecting into a mass of minute particles of a solid dispersed throughout a liquid (a sol), usually followed by the precipitation or system (hyper- and hypocoagulable states).
In this Stroke CME section, Naidech and Weisberg (2) discuss the role of chronic hypertension in stroke, Kelley and Minagar (3) describe cardioembolic stroke, and Kahn (4) outlines the common causes of hypercoagulable states in stroke. To know how to treat stroke, it is vital to know the brain and cerebral and vascular disturbances, and the imaging studies commonly obtained are outlined by Xavier et al. (5) Medical and surgical treatment strategies are reviewed by Kirshner and Akers, (6) including the possible role of angioplasty and stents. When these treatment strategies are not effective, acute stroke may occur. Vascular and neuroprotection strategies for treating patients who have sustained acute strokes are reviewed by Felberg and Naidech (7) and in a separate article by Zweifler. (8) Unfortunately, in some patients, these strategies are unsuccessful, and vascular cognitive impairment results. Strub reviews patients with such impairments. (9) Quite a distance has been traveled during the past decade in s troke management. I hope that medical science will further reduce the devastating dev·as·tate tr.v. dev·as·tat·ed, dev·as·tat·ing, dev·as·tates 1. To lay waste; destroy. 2. To overwhelm; confound; stun: was devastated by the rude remark. effect of stroke during the next decade. Accepted November 7, 2002. References (1.) Caplan LR. Now is an exciting time to care for stroke patients. South Med J 2003;96:329-330. (2.) Naidech A, Weisberg LA. Treatment of chronic hypertension for the prevention of stroke. South Med J 2003;96:359-362. (3.) Kelley RE, Minagar A. Cardioembolic stroke: An update. South Med J 2003;96:343-349. (4.) Kahn MJ. Hypercoagulability as a cause of stroke in adults. South Med J 2003;96:350-353. (5.) Xavier AR, Qureshi AI, Kirmani JF, Yahia AM, Bakshi R. Neuroimaging in stroke patients: A review. South Med J 2003;96:367-379. (6.) Kirshner HS. Medical prevention of stroke, 2003. South Med J 2003;96:354-358. (7.) Felberg RA, Naidech A. The 5 Ps of acute ischemic stroke treatment: Parenchyma Parenchyma A ground tissue of plants chiefly concerned with the manufacture and storage of food. The primary functions of plants, such as photosynthesis, assimilation, respiration, storage, secretion, and excretion—those associated with living , pipes, perfusion, penumbra penumbra (pĭnŭm`brə): see eclipse; sunspots. , and prevention of complications. South Med J 2003;96:336-342. (8.) Zweifler RM. Management of acute stroke. South Med J 2003;96:380-386. (9.) Strub R. Vascular dementia. South Med J 2003;96:363-366. From the Department of Psychiatry and Neurology, Tulane University School of Medicine History Founded in 1834, Tulane University School of Medicine is the 15th oldest medical school in the United States. Today the medical school is but one part of the Tulane University Health Sciences Center, which includes the School of Medicine, the Tulane University Hospital , New Orleans, LA. Reprint requests to Leon A. Weisberg, MD, Department of Psychiatry and Neurology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112. Email: weisberg@tulane.edu Copyright [c] 2003 by The Southern Medical Association 0038-4348/03/9604-0331 |
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