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THE BARE ESSENTIALS
Stroke is a major public health problem because it is frequent, dangerous and expensive. Moreover, it can often be prevented, and may now be treatable in the acute stage. We will not cover subarachnoid haemorrhage here, which has a different clinical presentation and management from ischaemic stroke and spontaneous intracerebral haemorrhage (ICH), nor stroke rehabilitation.
The incidence of stroke is now higher than that of acute coronary syndromes. Patients with incident strokes are the target for acute stroke management (fig 1).
Stroke is the most prevalent neurological disorder under the age of 85 years. Patients with prevalent stroke and transient ischaemic attacks (TIA) are the target for secondary prevention.
Stroke is associated with increased long-term mortality, residual physical, cognitive, and behavioural impairments, recurrence, and increased risk of other types of vascular event, such as myocardial infarction.
The direct cost of stroke is high, for instance in Germany the lifetime cost is about €40 000.
IS THIS PATIENT HAVING A STROKE?
Stroke is characterised by a sudden or rapidly developing loss of cerebral function without any other cause than vascular, and includes both infarcts and haemorrhages. The classical definition requires the symptoms to last more than 24 hours, except in the case of early death. Although sometimes one or more are missing, the three clinical features suggesting a stroke are:
Sudden onset of symptoms and signs, either all at once within seconds or developing over a few minutes, and often worsening over the next minutes or hours, then stabilising and improving over time.
Focal symptoms and signs, that is, generally explained by a single lesion in the brain (boxes 1 and 2). Note: the symptoms and signs may not necessarily be explained by a single lesion when the patient has already had a stroke, or develops several acute strokes in different territories.
“Negative” symptoms …
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