'Brain attack'

The rationale for treating stroke as a medical emergency

P. J. Camarata, R. C. Heros, Richard E Latchaw, D. G. Piepgras, J. P. Whisnant, R. R. Smith

Research output: Contribution to journalArticle

124 Citations (Scopus)

Abstract

STROKE IS THE third leading cause of death in the United States, behind only heart disease and cancer. With an estimated three million survivors of stroke in the United States, the cost to society, both directly in health care and indirectly in lost income, is staggering. Despite recent advances in basic and clinical neurosciences, which have the potential to improve the treatment of acute stroke, the general approach to the acute stroke patient remains one of therapeutic nihilism. Most 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 neuroprotective agents must also be administered within a short time frame to be effective at salvaging at-risk tissue. Recent studies have suggested that the outcome after intracerebral and subarachnoid hemorrhage is improved with early intervention. However, most stroke patients fail to present to medical attention within this short 'window of opportunity.' 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 decades as a guide for shaping changes in the management of acute stroke. Comprehensive educational efforts aimed at clinicians and the public at large have dramatically reduced the time from symptom onset to presentation and treatment for acute myocardial infarction, enabling treatment methods such as thrombolysis to be effective. The Decade of the Brain offers a unique opportunity to all concerned with the treatment of the 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 there are few therapeutic interventions of 'proven' value in the treatment of acute stroke, there is more than sufficient suggestive evidence that a number of approaches may be beneficial within the first few hours after the onset of the stroke.

Original languageEnglish (US)
Pages (from-to)144-158
Number of pages15
JournalNeurosurgery
Volume34
Issue number1
StatePublished - 1994
Externally publishedYes

Fingerprint

Emergencies
Stroke
Brain
Myocardial Infarction
Therapeutics
Heart Neoplasms
Cerebral Hemorrhage
Neuroprotective Agents
Subarachnoid Hemorrhage
Neurosciences
Survivors
Cause of Death
Heart Diseases
Myocardium
Delivery of Health Care
Costs and Cost Analysis

Keywords

  • Cerebral hemorrhage
  • Cerebral ischemia
  • Stroke
  • Stroke therapy
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Camarata, P. J., Heros, R. C., Latchaw, R. E., Piepgras, D. G., Whisnant, J. P., & Smith, R. R. (1994). 'Brain attack': The rationale for treating stroke as a medical emergency. Neurosurgery, 34(1), 144-158.

'Brain attack' : The rationale for treating stroke as a medical emergency. / Camarata, P. J.; Heros, R. C.; Latchaw, Richard E; Piepgras, D. G.; Whisnant, J. P.; Smith, R. R.

In: Neurosurgery, Vol. 34, No. 1, 1994, p. 144-158.

Research output: Contribution to journalArticle

Camarata, PJ, Heros, RC, Latchaw, RE, Piepgras, DG, Whisnant, JP & Smith, RR 1994, ''Brain attack': The rationale for treating stroke as a medical emergency', Neurosurgery, vol. 34, no. 1, pp. 144-158.
Camarata PJ, Heros RC, Latchaw RE, Piepgras DG, Whisnant JP, Smith RR. 'Brain attack': The rationale for treating stroke as a medical emergency. Neurosurgery. 1994;34(1):144-158.
Camarata, P. J. ; Heros, R. C. ; Latchaw, Richard E ; Piepgras, D. G. ; Whisnant, J. P. ; Smith, R. R. / 'Brain attack' : The rationale for treating stroke as a medical emergency. In: Neurosurgery. 1994 ; Vol. 34, No. 1. pp. 144-158.
@article{99f9b5a026434c40a273fb79f2ba59cb,
title = "'Brain attack': The rationale for treating stroke as a medical emergency",
abstract = "STROKE IS THE third leading cause of death in the United States, behind only heart disease and cancer. With an estimated three million survivors of stroke in the United States, the cost to society, both directly in health care and indirectly in lost income, is staggering. Despite recent advances in basic and clinical neurosciences, which have the potential to improve the treatment of acute stroke, the general approach to the acute stroke patient remains one of therapeutic nihilism. Most 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 neuroprotective agents must also be administered within a short time frame to be effective at salvaging at-risk tissue. Recent studies have suggested that the outcome after intracerebral and subarachnoid hemorrhage is improved with early intervention. However, most stroke patients fail to present to medical attention within this short 'window of opportunity.' 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 decades as a guide for shaping changes in the management of acute stroke. Comprehensive educational efforts aimed at clinicians and the public at large have dramatically reduced the time from symptom onset to presentation and treatment for acute myocardial infarction, enabling treatment methods such as thrombolysis to be effective. The Decade of the Brain offers a unique opportunity to all concerned with the treatment of the 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 there are few therapeutic interventions of 'proven' value in the treatment of acute stroke, there is more than sufficient suggestive evidence that a number of approaches may be beneficial within the first few hours after the onset of the stroke.",
keywords = "Cerebral hemorrhage, Cerebral ischemia, Stroke, Stroke therapy, Subarachnoid hemorrhage",
author = "Camarata, {P. J.} and Heros, {R. C.} and Latchaw, {Richard E} and Piepgras, {D. G.} and Whisnant, {J. P.} and Smith, {R. R.}",
year = "1994",
language = "English (US)",
volume = "34",
pages = "144--158",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - 'Brain attack'

T2 - The rationale for treating stroke as a medical emergency

AU - Camarata, P. J.

AU - Heros, R. C.

AU - Latchaw, Richard E

AU - Piepgras, D. G.

AU - Whisnant, J. P.

AU - Smith, R. R.

PY - 1994

Y1 - 1994

N2 - STROKE IS THE third leading cause of death in the United States, behind only heart disease and cancer. With an estimated three million survivors of stroke in the United States, the cost to society, both directly in health care and indirectly in lost income, is staggering. Despite recent advances in basic and clinical neurosciences, which have the potential to improve the treatment of acute stroke, the general approach to the acute stroke patient remains one of therapeutic nihilism. Most 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 neuroprotective agents must also be administered within a short time frame to be effective at salvaging at-risk tissue. Recent studies have suggested that the outcome after intracerebral and subarachnoid hemorrhage is improved with early intervention. However, most stroke patients fail to present to medical attention within this short 'window of opportunity.' 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 decades as a guide for shaping changes in the management of acute stroke. Comprehensive educational efforts aimed at clinicians and the public at large have dramatically reduced the time from symptom onset to presentation and treatment for acute myocardial infarction, enabling treatment methods such as thrombolysis to be effective. The Decade of the Brain offers a unique opportunity to all concerned with the treatment of the 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 there are few therapeutic interventions of 'proven' value in the treatment of acute stroke, there is more than sufficient suggestive evidence that a number of approaches may be beneficial within the first few hours after the onset of the stroke.

AB - STROKE IS THE third leading cause of death in the United States, behind only heart disease and cancer. With an estimated three million survivors of stroke in the United States, the cost to society, both directly in health care and indirectly in lost income, is staggering. Despite recent advances in basic and clinical neurosciences, which have the potential to improve the treatment of acute stroke, the general approach to the acute stroke patient remains one of therapeutic nihilism. Most 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 neuroprotective agents must also be administered within a short time frame to be effective at salvaging at-risk tissue. Recent studies have suggested that the outcome after intracerebral and subarachnoid hemorrhage is improved with early intervention. However, most stroke patients fail to present to medical attention within this short 'window of opportunity.' 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 decades as a guide for shaping changes in the management of acute stroke. Comprehensive educational efforts aimed at clinicians and the public at large have dramatically reduced the time from symptom onset to presentation and treatment for acute myocardial infarction, enabling treatment methods such as thrombolysis to be effective. The Decade of the Brain offers a unique opportunity to all concerned with the treatment of the 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 there are few therapeutic interventions of 'proven' value in the treatment of acute stroke, there is more than sufficient suggestive evidence that a number of approaches may be beneficial within the first few hours after the onset of the stroke.

KW - Cerebral hemorrhage

KW - Cerebral ischemia

KW - Stroke

KW - Stroke therapy

KW - Subarachnoid hemorrhage

UR - http://www.scopus.com/inward/record.url?scp=0028084901&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028084901&partnerID=8YFLogxK

M3 - Article

VL - 34

SP - 144

EP - 158

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 1

ER -