Medical and Surgical Management of Stroke• Because it contains material concerned with the many critical problems of diagnosis, differential diagnosis, and treatment which arise when a patient presents with a possible stroke, Medical and Surgical Management is one of the most important Sections to appear in this series of publications from the Joint Committee for Stroke Facilities. Practical aspects of the management of transient ischemic attacks (TIA), strokes-inevolution, completed strokes, and the comatose patient are discussed in detail, and attempts made to distinguish between ischemic and hemorrhagic stroke. Recommendations of the study group are listed.
Foreword• The group studying management of the stroke patient was charged with responsibility for developing optimal, yet feasible, methods adaptable to community and referral hospitals. It soon became evident that there is an optimal goal for good care, and that artificial division into several levels (depending on hospital or community size) might render disservice to the patient. The study group and their consultant subgroups have labored to produce a report providing current information on the best diagnosis and treatment with full knowledge that new discoveries will change radically approaches to some of these problems. One conclusion is certain-that the term "stroke" no longer can be considered as referring to a single all-inclusive diagnosis. The condition has many ramifications calling for great diagnostic and therapeutic precision and individualization. In addi- tion, we wish to emphasize that much more can be done to treat patients today than was possible a decade ago.Many initial disagreements had to be resolved; however, in some areas, no consensus can be reached because available data allow for different viewpoints. In such instances, a middle road was chosen, neither endorsing nor rejecting controversial modes of treatment. In future years the gaps in our knowledge may be closed, allowing definite statements to be made about these areas of uncertainty.By prior agreement we have excluded consideration of intracranial hemorrhage secondary to trauma, and spinal cord vascular disease. Furthermore, we have not discussed in detail the facilities and personnel necessary to carry out the regimens outlined in our report. Lastly, laboratory tests and special procedures, such as lumbar puncture, are We will outline briefly methods by which the stroke-suspect patient should be evaluated. Details of these examinations are available in modern texts of medicine and neurology. We propose to discuss the management of transient ischemic attacks (TIA), occlusion and hemorrhage in the major vessels of the brain (carotid and vertebral-basilar systems), and the comatose patient.
Evaluation of the Stroke-Suspect Patient
INITIAL EVALUATIONThe patient with neurological symptoms and signs is evaluated most often at home, in the office, or in the emergency room by a physician who may see relatively few persons with neurological complaints. What follows is our concept ...