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Contents
Introduction
Apoplexy, an old term for stroke, has been recognised for
nearly 2,500 years but the cause was unknown and was usually
attributed to an imbalance in the ‘four vital humours’ or
to an interruption of ‘vital spirits’ in the brain. In the
second century AD, Aretaeus of Cappadocia came closer to the
mark when he attributed apoplexy to a congestion of blood
flow. Following his insight, it took until the 1600s for the
next advances to emerge, namely the discovery of blood circulation
and the recognition that interrupted brain blood flow resulted
in apoplexy. By the 1800s, diseased blood vessels had been
identified as a cause of stroke, the term ‘ischaemic apoplexy’
had been introduced, and bleeding into or around the brain
– haemorrhage – had been recognised as another cause.
Major advances in the twentieth century include the development
of arteriography, in which an injected dye enables
the arteries feeding the brain to be ‘seen’ using X-rays.
In this way, a blood clot in the carotid artery was made visible
for the first time in 1936. Today, powerful techniques such
as computed tomography (CT) and magnetic resonance imaging
(MRI) allow neurologists to study the living brain, pinpoint
the location of a stroke and often distinguish between ischaemic
and haemorrhagic strokes. The early separation of these two
(i.e. within hours) is vitally important, because it influences
the type of treatment required.
During 1998, a panel of the Royal College of Physicians of
Edinburgh urged ‘...the further development of well-organised
and co-ordinated stroke services’, and concluded that
there is ‘...good evidence that these lead to improved
patient outcomes’. Separately, the World Health Organisation
issued international guidelines to improve stroke care. In
the UK, we are now moving towards an integrated approach to
stroke management, encompassing primary prevention, secondary
prevention, acute care, rehabilitation and better co-ordination
of stroke services. This will help achieve the target in the
Government’s Green paper, Our Healthier Nation, which aims
to reduce stroke in under 65 year olds by 30 per cent from
its 1996 level by the year 2010.
If this is achieved, both the human and financial burden
of stroke will be greatly reduced. Cerebrovascular disease
(mostly stroke) cost the NHS about £1.76 billion in 1995/96,
or about 5 per cent of all NHS expenditure. Of this, 76 per
cent was for hospital treatment, 22 per cent for medicines
including prescribing costs, and the remainder for GP consultations.
Stroke also results in 7.7 million lost working days each
year, representing over £450 million in lost production. Estimates
from The Stroke Association suggest a combined NHS and Social
Services cost of stroke of £2.3 billion.
Although prevention must be a primary aim, there remains
an urgent need for medicines that reduce brain damage in the
critical hours after a stroke. With the development of new
medicines and a more integrated approach to the management
of stroke, the prospects for people who have had a stroke
are steadily improving. This booklet seeks to provide some
basic information about the nature of stroke and its diagnosis
and an account of current and future medicines in research
and development.
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