BRAIN ATTACK - THE RATIONALE FOR TREATING STROKE AS A MEDICAL EMERGENCY

STROKE IS THE third leading cause of death in the United States, behin d only heart disease and cancer. With an estimated three million survi vors of stroke in the United States, the cost to society, both directl y in health care and indirectly in lost income, is staggering. Despite recent advances in basic and clinical neurosciences, which have the p otential to improve the treatment of acute stroke, the general approac h to the acute stroke patient remains one of therapeutic nihilism. Mos t basic science studies show that to be effective, acute intervention to reperfuse ischemic tissue must take place within the first several hours, as is the case with ischemic myocardium. In addition, most neur oprotective agents must also be administered within a short time frame to be effective at salvaging at-risk tissue. Recent studies have sugg ested that the outcome after intracerebral and subarachnoid hemorrhage is improved with early intervention. However, most stroke patients fa il to present to medical attention within this short ''window of oppor tunity.'' The public's knowledge about stroke is woefully inadequate. However, clinicians who deal with stroke can use the dramatic changes in the treatment of acute myocardial infarction over the last 2 decade s as a guide for shaping changes in the management of acute stroke. Co mprehensive educational efforts aimed at clinicians and the public at large have dramatically reduced the time from symptom onset to present ation and treatment for acute myocardial infarction, enabling treatmen t methods such as thrombolysis to be effective. The Decade of the Brai n offers a unique opportunity to all concerned with the treatment of t he patient with acute stroke to engage in a concerted effort to bring patients with a ''brain attack'' to specialized neurological attention within the same timeframe that the 'heart attack'' patient is handled . Such an effort is justified because, although at the present time th ere are few therapeutic interventions of ''proven'' value in the treat ment of acute stroke, there is more than sufficient suggestive evidenc e that a number of approaches may be beneficial within the first few h ours after the onset of the stroke.