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(Stroke. 2003;34:2764.)
© 2003 American Heart Association, Inc.

Controversies in Stroke

Stroke Is Best Managed by a Neurologist: Battle of the Titans

From the University Department of Medicine & Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, UK.

Correspondence to Prof Kennedy R. Lees, University of Glasgow, University Dept of Medicine & Therapeutics, Western Infirmary, Glasgow G11 6NT, Scotland, UK. E-mail k.r.lees@clinmed.gla.ac.uk

Key Words: neurologist • specialties, medical • stroke management

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

The world was created out of chaos. Early after the first immortals appeared on the scene, the titan Cronus and his brothers defended themselves against the future gods of Olympus for dominion, and lost. The titans were imprisoned in the bowels of the earth, while the victorious Olympian gods ascended, bringing new values and concepts into the world.

—Greek mythology

The Clinical Argument

The deficit in stroke is neurological but the cause is vascular, complications are medical, and treatment should be multidisciplinary: no single aspect is overriding. Stroke patients require holistic care, expertly delivered. Neither American nor European stroke management guidelines mandate that a neurologist should deliver care.^1,2 Let us examine the neurologist’s potential role in the patient journey.

Clinical Assessment

Although management is rarely influenced directly, lesion localization may be a specialist neurology task. The accuracy of clinical localization improves with the seniority of the neurologist, but modern cerebral imaging is supplanting this role. Severity scales are well applied by stroke nurses.³ Disability assessment is not the sole province of neurologists; indeed, few have undergone formal training in Rankin, Barthel, FIM, etc. Vascular risk factor assessment can be ably undertaken by internists and cardiologists: serious concomitant disease is typically cardiovascular.

Investigation

Stroke clinicians can order CT or MRI scans and learn to interpret stroke signs on imaging.⁴ The various ultrasound tests are often performed by technicians or specialist radiology staff. Few tests needed for TOAST classification directly involve the brain.⁵ The increasing use of protocols further limits the role of the diagnostician.

Differential Diagnosis

This is the . . . [Full Text of this Article]

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