ISSUES AND ANSWERS IN STROKE CARE

In this section we address three aspects of stroke care that are impor tant yet could not be reviewed in depth. The first is the organisation of stroke care (stroke units), in the acute phase as well as in the r ehabilitation phase. The type of stroke services that hospitals provid e varies considerably from place to place. To some extent this reflect s differences in local conditions and needs, but at least there is now good evidence that hospital-based stroke services need to be organise d. Which proportion of stroke patients needs formal rehabilitation dep ends on case-mix, with age and severity of stroke being the main facto rs. A rough estimate is that 20% of patients die within 30 days, and t hat 40-60% of survivors remain functionally dependent at the end of th at period.The second issue is that of vascular cognitive impairment an d its prevention. The increasing sensitivity of neuro-imaging techniqu es has revived the notion of chronic ischaemia as a cause of mental de cline. The intellectual changes are mostly mild but the high prevalenc e makes this disorder a major health problem. Lastly, cost-effectivene ss of hospital care for stroke patients is a controversial issue, give n the great variation across Europe in the proportion of stroke admiss ions.