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(Stroke. 1997;28:1835-1839.)
© 1997 American Heart Association, Inc.

Articles

Some Clinical Aspects of Acute Stroke

Excellence in Clinical Stroke Award Lecture

J.P. Mohr

From the Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY.

Correspondence to J.P. Mohr, MD, Stroke Unit Neurological Institute, Columbia-Presbyterian Medical Center, 710 W 168th St, New York, NY 10032-2603. E-mail jpm10@columbia.edu

	Introduction

 
None of us in current neurology regret the passage of the "diagnose and adios" era humorously criticized years ago by Dr Labe Scheinberg in a grand rounds talk. Rapid innovations in imaging, the rush to ever more clinical trials, and the shortening time frame for action are turning many of us into happy interventionists, rivaling colleagues in cardiology and emergency medicine.

The very pace of events is quickly rendering obsolete the more leisurely approach to the analysis of the meaning of symptoms and signs. The practical needs dictated by hyperacute therapy threaten to change our field so thoroughly as to eclipse the once intensely debated clinical issues of how the brain responds to injury, for which stroke has always been the leading model. Proposals for four areas referable to clinical stroke research are offered, including those for clinical trials.

	TIA and Stroke

 
The first proposal is that we adopt a "1-hour rule" for diagnosing stroke. Approaching the end of the 20th century, clinical trialists are still hobbled by the now-outmoded 24-hour rule. This, a working definition, not one handed down by the Great Neurologist, was created in the trials in the 1950s by default: beyond 24 hours, there was general agreement that the syndrome was a stroke; less than that, it was uncertain.¹ Proposals for a 1-hour definition were made soon after but with little success, lacking modern imaging.² Transient ischemic attacks (TIAs) in a setting of high-grade carotid stenosis typically last minutes,³ which argues for a dichotomy between TIA and stroke for . . . [Full Text of this Article]

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