With a Little Help From My Friends
Seeking Consistent and Persuasive Evidence
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“I get by with a little help from my friends.”
— The Beatles, 19671
The past 30 years have seen remarkable advances in all areas of medicine, but perhaps none more so than stroke. On the 10th anniversary of the passing of Dr David Sherman, scholar, compassionate clinician, leader, family man, and friend, it is appropriate to consider the progress we have made in large part from his leadership. The care of patients with stroke was much different in 1984 when I joined the faculty of the School of Medicine at the University of Virginia. Stroke was still the third leading cause of death right behind heart disease and cancer. Patients with stroke were generally cared for by primary care physicians, and neurologists and neurosurgeons were largely adnexal. There was no approved acute treatment. For neurologists, our main job was to consult the next day to localize the lesion, provide some help with prognosis, and help decide who should be on heparin infusions. Although computed tomography was widely available by then, MRI was still in development. We had carotid ultrasound, and transcranial Doppler was just being introduced, but the only reliable way to see the cerebral vasculature was with catheter angiography with its attendant risks. Warfarin was widely used for stroke prevention but not for atrial fibrillation. The only proven stroke preventative, aside from risk factor control, was aspirin.
Fast forward to now, and what a different world in which we live! Stroke has slipped to fifth from third on the list of causes of death of Americans.2 Stroke teams, stroke units, and stroke centers led by specialists are widely distributed. Intravenous tissue-type plasminogen activator (tPA) is approved for treatment of …