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(Stroke. 2003;34:2765.)
© 2003 American Heart Association, Inc.

Controversies in Stroke

Neurologist, Internist, or Strokologist?

From The National Stroke Research Institute (G.A.D.), Austin and Repatriation Medical Centre and University of Melbourne, and the Department of Neurology (S.M.D.), Royal Melbourne Hospital and University of Melbourne, Australia.

Correspondence to Prof Stephen M. Davis, Department of Neurology, Royal Melbourne Hospital, Parkville Victoria 3050, Australia. E-mail stephen.davis@mh.org.au

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

After all, clinical medicine is above all the study of the difficult aspects and complexities of diseases. When a patient calls on you, he is under no obligation to have a simple disease just to please you.

—J.-M. Charcot, 1887

Stroke is a complex disease involving not only the brain, but many other organ systems. Hence, special skills are required. So who cares for the 20 million strokes that occur each year globally? The reality is that only a small proportion are managed by neurologists, although this varies from country to country. Even so, of all the disease entities treated by neurologists, stroke is by far the largest public health problem. Are the skills required for stroke management unique to neurology? Probably not.

The revolution in imaging and better understanding of cerebrovascular pathology has underpinned a radical change in stroke neurology, from elegant localization and clinical phenomenology to an emphasis on therapy. Neurologists were the quintessential specialists with unique skills linking alterations in brain anatomy with their clinical expression, exemplified by the detailed traditional and hierarchical neurological examination. While they were undoubtedly equipped to service Rolls Royces, they often showed little interest in less prestigious vehicles. Neurology has, therefore, traditionally been a consultant specialty with much less involvement in ongoing management. Even in the era of urgent therapeutic intervention, typified by thrombolysis, many neurologists have been slow to embrace this changing role. Indeed, probably the most important therapeutic advance in stroke medicine, namely coordinated care in stroke units, has often . . . [Full Text of this Article]

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