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(Stroke. 2003;34:2763.)
© 2003 American Heart Association, Inc.

Controversies in Stroke

Stroke Is Best Managed by Neurologists

From the Department of Neurology, Beth Israel Deaconess Medical Centre, Boston, Mass.

Correspondence to Dr Louis R. Caplan, Beth Israel Deaconess Medical Centre, Department of Neurology, Dana 779, 330 Brookline Ave, Boston, MA 02215-5400. E-mail lcaplan@caregroup.harvard.edu

Key Words: neurologist • stroke management • stroke units

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Stroke care is now managed in and out of dedicated stroke units. All agree that stroke units are worthwhile. But who should run them and who participate? Choice of physician personnel should depend on the type of unit, what participants need to know and to do, and who is available.

The most advanced stroke units provide cutting edge care from arrival in the emergency room until rehabilitation. They have ready access to advanced diagnostic and therapeutic technologies and treatments and have physician coverage 24 hour a day, 7 days a week. These units require the following:

(A) One or more physicians with intimate knowledge of brain anatomy, function, and cervicocranial blood supply. These physicians know the symptoms and signs found in stroke patients and the detailed differential diagnosis of stroke subtypes. They are very familiar with the symptoms, signs, and diagnosis of other neurological disorders. They are knowledgeable about stroke recovery and rehabilitation.

(B) One or more physicians who are competent and experienced in monitoring and treating acute and chronic cardiovascular and cardiopulmonary abnormalities and are familiar with the medical complications found in stroke patients and how to prevent and manage them if they occur.

The great majority of A-type physicians are neurologists, but some internists are interested and some are potentially educable. With training and experience they could fulfill the A-type job description. Similarly, neurologists, especially those with intensive care unit training, can become competent as B-type physicians, and many now are. Most guidelines emphasize that physician eligibility to . . . [Full Text of this Article]

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