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The Impact of Stroke

Article  in  British Medical Bulletin · February 2000

DOI: 10.1258/0007142001903120 · Source: PubMed

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Charles Wolfe
King's College London
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Preface
It is an exciting time to be involved in treating patients with stroke.
Investment in epidemiology, neuroscience research and clinical trials over
the final 20 years of the last century is beginning to show dividends which
will improve patient care. The advent of thrombolysis as an acute
treatment for stroke and the promise of neuroprotection are transforming
the approach to stroke, which is now seen as a 'brain attack' to be treated
as an emergency, rather than a 'cerebrovascular accident' for which
nothing can be done. There is good evidence that stroke units, where
patients can take advantage of optimised medical therapy, surgical
treatment and rehabilitation, result in significant benefits in terms of

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better outcomes compared to routine general medical care. The
treatments available to prevent stroke recurrence now include several
alternative antiplatelet regimens, anticoagulation, carotid surgery and
stenting. Clinical trials provide data to demonstrate the risks and benefit
of individual treatments, and to calculate cost. Both surgery and stenting
still carry undesirable risks, but recent technical developments are likely
to enhance the safety of these procedures. Impressive advancements in
imaging, including ultrasound, new CT and MR techniques are making a
dramatic difference to our ability to diagnose stroke acutely, image the
cerebral blood supply non-invasively and predict prognosis. These
advances are reviewed in this millennium volume of the British Medical
Bulletin, which concentrates on data relevant to clinical management of
stroke. We have managed to assemble an impressive collection of neuro-
logists, stroke physicians, radiologists, epidemiologists and surgeons, who
all have a special interest in stroke and are experts m their own field. The
resulting volume emphasises the British approach to stroke, which
involves the practical application of evidence-based medicine, combined
with multidisciplinary management and rehabilitation. We hope our
readers enjoy reading the volume and find it useful.

Martin M Brown
Professor of Stroke Medicine
Institute of Neurology
University College London
London, UK
E-mail: m.brown@ion.ucl.ac.uk

British Medical Bulletin 2000, 56 (No 2) v C The Brrtish Council 2000

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