Stroke: early pathophysiology and treatment. Summary of the Fifth Annual Decade of the Brain Symposium.

T he National Foundation for Brain Research convened a panel* of leading basic and clinical research scientists from academia, government, and the private sector to present an overview of recent advances in the understanding of the early processes leading to stroke and of treatment options to prevent stroke or ameliorate the damage. The symposium, held on May 10,1994, in Washington, DC, focused on (1) the significance and basic pathophysiology of stroke; (2) early recognition and diagnosis of stroke; and (3) early treatment of stroke. Stroke is a medical emergency and requires the same immediate response that a heart attack receives. In fact, stroke is a "brain attack." Despite recent advances in basic and clinical neurosciences that have the potential to improve treatment of acute stroke, the general approach to treating such patients remains one of therapeutic nihilism. The lack of public knowledge about the symptoms and seriousness of stroke also contributes to the problem. In a 1989 survey conducted by the Amer-ican Heart Association in San Francisco, almost two thirds of those surveyed were unable to identify correctly any of the early warning signs of stroke from a list of symptoms. Yet 90% could name at least one major sign of heart attack. The distinguished panel of speakers at the Fifth Annual DECADE OF THE BRAIN Symposium sponsored by the National Foundation for Brain Research provided an overview of current and new concepts in stroke research and treatment strategies. The window of opportunity to ameliorate and prevent secondary damage from stroke may be widened through some of the maneuvers described by several speakers. In addition, educational efforts need to be enhanced to recognize stroke as a brain attack and a medical emergency requiring rapid transport of the patient to medical care and prompt initiation of treatment. Dr Patricia Grady reviewed areas of research that have contributed to the understanding of stroke, much of it funded by the federal government through the National Institute of Neurological Disorders and Stroke (NINDS), a unit of the National Institutes of Health. She cited past research that delineated stroke risk factors including smoking, high blood pressure, age, previous stroke, race, and sex. Federally funded studies now under way are aimed at strategies to prevent Sponsored by the National Foundation for Brain Research in cooperation with the American Heart Association. 'Full names and affiliations of the speakers appear at the end of this article. secondary injury, …