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(Stroke. 2004;35:e149.)
© 2004 American Heart Association, Inc.

Letters to the Editor

Stroke Is Best Managed by Neurologists

Department of Neurological Sciences, University of Rome "La Sapienza"

Key Words: critical care • stroke management • stroke curriculum

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

To the Editor:

We read with great interest the Controversies in Stroke segment published in November, 2003, which discusses whether it is neurologists or internists who are most suited to manage stroke patients.^1–3

Caplan, Lees, and Donnan set out the problem so clearly that there is little else we can do, we feel, but agree, on behalf of the Italian Study Group in Cerebrovascular Disease, the Italian Society of Neurology, and the Italian Society of Neurologists, Neurosurgeons, and Neuroradiologists, with all three authors.

We agree with Donnan when he says that "stroke is a complex disease involving not only the brain," just as we do with Lees when he says that "the deficit in stroke is neurological but the cause is vascular, complications are medical, and treatment should be multidisciplinary."

It is also true that "stroke care is now managed in and out of dedicated stroke units." Consequently, how can we deny that "special skills are required" (Donnan), or that "stroke patients require holistic care, expertly delivered" (Lees)?

Assuming that this is the problem, the solution is a highly complex one. We do need a strokologist, though not exclusively for the very early management of patients in a dedicated stroke unit.

We agree with Lees’s view that "secondary prevention is a long-term activity" and that "few neurologists play a direct practical role in the management of blood pressure or atrial fibrillation, use of statins, PFO closure, carotid stenting, or endarterectomy."

We should add that neither neurologists nor clinicians who are . . . [Full Text of this Article]