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{{WPMED|class=B|importance=Top|neurology=yes|neurology-imp=Top}}
{{WP1.0|v0.5=pass|class=B|category=Natsci}}

==Some==
:Some people think that [[ischemic stroke]] is caused by excessive calcium ions triggered by lack of enough blood circulation. [http://news.bbc.co.uk/2/hi/health/4207041.stm]
::Yeah, the role of calcium in [[excitotoxicity]] is very well supported. This topic is treated in [[ischemic cascade]]. --[[User:Delldot|Delldot]] 15:49, 28 October 2005 (UTC)

----
this article needs to address some basic questions, incl:

Q. what is the average person's risk of stroke per year? what if they are a smoker?
* http://www.theuniversityhospital.com/stroke/stats.htm

== Cerebral hemorrhage ==

I just came across the [[cerebral hemorrhage]] article a little while ago. It seems that it used to be a redirect to this article, but isn't anymore (starting November 2004). Should it point here? [[User:Mulad|<nowiki></nowiki>]] &mdash;[[User:Mulad]] [[User talk:Mulad|(talk)]] 05:04, Mar 2, 2005 (UTC)
: I agree [[cerebral hemorrhage]] should merge with and redirect to [[Cerebrovascular accident]]. [[Cerebral hemorrhage]] is unlikely to have enough content to stand on its own without duplicating info already in [[cerebrovascular accident]]. -- [[User:PFHLai|PFHLai]] 08:53, 2005 Mar 2 (UTC)
:: [[Cerebral hemorrhage]] now redirects here. [[User:Alex.tan|Alex.tan]] 06:53, August 11, 2005 (UTC)
::: I've added a whole bunch of information to [[hemorrhagic stroke]] so I thought it needed its own page. [[Stroke]] is already a little long and unruly, I think. Plus, hemorrhagic stroke is really different in mechanism, treatment, epidemiology, prognosis, and risk factors than ischemic. I'd also like to take the treatment for hemorrhagic stroke from this article and into the hem stroke article, leaving a blurb. Let me know what you think.

::: Cerebral hemorrhage can be caused by brain trauma, and [[intracerebral hemorrhage]] has its own stub. Cerebral hemorrhage currently redirects to hemorrhagic stroke, but should it redifect to the stub with a link in the article to hemorrhagic stroke? --[[User:Delldot|Delldot]] 15:49, 28 October 2005 (UTC)

::: [[Hemorrhagic stroke]] now points here. [[Cerebral hemorrhage]] has not been touched. Reason is ICH and SAH are two big topics that can't fit in [[cerebral hemorrhage]] anyways, hemorrhagic stroke was briefly added in [[stroke]] with ICH and SAH linked.

::: Original author of [[cerebral hemorrhage]] has authorized merge into [[stroke]] so I will redirect it soon if there's no objections. [[User:Andrewr47|Andrewr47]] 22:38, 6 April 2006 (UTC)

"On average, a stroke occurs every 45 seconds and someone dies every 3 minutes."
- I don't think that this is entirely relevant. -- Johnt --[[User:81.174.140.179|81.174.140.179]] 21:27, 11 December 2006 (UTC)

== CVA should redirect to stroke ==

There is a growing consensus among neurologists researching and managing stroke, that the term "cerebrovascular Accident (CVA)" should be abandoned in favour of "stroke". The purpose of the change is to highlight the fact that stroke is not an "accident" like a lightning strike, but a '''treatable''' brain disorder with known and often '''preventable''' risk factors. This is especially true with the advent of thrombolysis and endovascular intervention for stroke.

I'd like to rejig the redirect so that '''Stroke''' is the main articla, and [[CVA]] and [[cerebrovascular accident]] redirect to it. There would also be a textual edit to reflect and possibly highlight the change.

Any thoughts?

(FWIW I am a neurogist at the National Hospital for Neurology and Neurosurgery, London, which includes University College London Hospitals NHS Trust Acute Brain Injury Unit.)

--[[User:Dubbin|Dubbin]] 17:51, 23 September 2005 (UTC)

==Requested move==

:''Add *'''Support''' or *'''Oppose''' followed by an optional one sentence explanation, then sign your vote with <nowiki>~~~~</nowiki>''

* '''Support'''. But you might want to also post the suggestion at [[Wikipedia:Requested moves]]. --[[User:Arcadian|Arcadian]] 19:55, 23 September 2005 (UTC)
* '''N'''eutral. I have not heard about the renaming, and I hear the terms being used interchangeably. I am willing to effect the move (which will involve deleting redirects) if consensus can be reached here. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 16:42, 26 September 2005 (UTC)
*'''Support''' Most neurologists I know favor stroke over CVA. It's also nice that it's a term well-known in the lay community [[User:InvictaHOG|InvictaHOG]] 06:17, 30 September 2005 (UTC)
*'''Oppose''' (strong) The name by which all other doctors and the textbooks refer to is CVA, if this is seen as an unpleasant (un-PC) term for use by neurologist when talking to patients, then fine, but the technical term used in coding systems is still CVA. [[User:Davidruben|David Ruben]]<sup>[[User talk:Davidruben|talk]]</sup> 00:19, 1 October 2005 (UTC)
*'''Oppose''' Some hospitals are trying to call these "Brain attacks" instead of "strokes" but textbooks still refer to these as CVA's. The term "Stroke" is to "CVA" what "Heart attack" is to "Myocardial infarction" [[User:Sirhodges|Sirhodges]] 02:01, 15 November 2007 (UTC)

===Discussion===

:''Add any additional comments''
* Re oppose - as I understand things, the [[Wikipedia:WikiProject Clinical medicine|WikiProject Clinical medicine]] has generaly tended to use the technical rather than the lay term. Hence the [[Talk:Myocardial_infarction|agreement]] over [[Myocardial infarction]], with [[Heart Attack]] having the redirection. What are we going to do with [[Transient ischemic attack]]s, start naming the article "Mini-strokes" ? - [[User:Davidruben|David Ruben]]<sup>[[User talk:Davidruben|talk]]</sup> 00:19, 1 October 2005 (UTC)
* Also note that "stroke" has other meanings, normally therefore in WP "Stroke" would be a disambiguation page that links to amongst other things CVA, or "Stroke (medicine)" if you must. Unusually for WP, the current "Stroke" page has already reserved the medical use and there is a separate [[Stroke (disambiguation)]] page. Switching CVA to Stroke therefore risks others wishing to move it again and claim "Stroke" as the initial disambiguation page. - [[User:Davidruben|David Ruben]]<sup>[[User talk:Davidruben|talk]]</sup> 00:19, 1 October 2005 (UTC)
** As it is the most important use of the noun "stroke", all other terms are disambiguated from it. It is therefore an appropriate redirect. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 23:49, 1 October 2005 (UTC)
* Don't worry about "classification systems" and "other doctors". They'll learn that "CVA" is no longer the accepted term, just as they learned for "cretin", "insane" and "mongol". The change from CVA to "stroke" is neurologist-led, as is stroke medicine these days. Wikipedia should reflect the prevailing opinion within the appropriate specialty: in this case, neurology. And don't worry about "TIAs", either - when all stroke-like events are treated with thrombolysis or angioplasty within an hour of onset, this term will be defunct too. --[[User:Dubbin|Dubbin]] 23:45, 1 October 2005 (UTC)
** Dubbin, could you support this with professional society position documents etc etc? This would be immensely helpful. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 23:49, 1 October 2005 (UTC)
*** Off the top of my head, try [http://www.basp.ac.uk/2004strokeed.html] - the British Association of Stroke Physicians' educational documents page. Every reference to the phenomenon uses "stroke" rather than "CVA". Among specialists dealing with this condition, the term CVA is long dead. --[[User:Dubbin|Dubbin]] 23:55, 1 October 2005 (UTC)
* Citing "myocardial infarction" as the "technical" and therefore "correct" term argues against yourself: it is the name used by cardiologists, just as stroke is the term used among neurologists. "Stroke" also happens to have the advantage of being the commonly used lay term. --[[User:Dubbin|Dubbin]] 23:52, 1 October 2005 (UTC)

===Discision===
Page moved. <small>[[User:RN|Ryan Norton]] <sup><font color="#6BA800">[[User talk:RN|T]]</font> | <font color="#0033FF">[[Special:Emailuser/RN|@]]</font> | <font color="#FF0000">[[Special:Contributions/RN|C]]</font></sup></small> 01:47, 15 October 2005 (UTC)
Agree- The change should definitly be made. It's not about Lay terms vs. Technical terms, it's right vs. wrong. CVA is not the correct term anymore and this has been proven by neurologists. Stroke is not simply an "accident", but rather a condition for which the onset can be detected and prevented thanks to modern technology. I do agree that TIA should not change to "mini-strokes" however. The term Transient Ischemic Attack is more accurate than "mini-stroke", so it should remain as is. [[Special:Contributions/192.251.46.22|192.251.46.22]] ([[User talk:192.251.46.22|talk]]) 05:46, 5 March 2009 (UTC)

== PubMed links ==

{{User|128.248.65.105}} added some URLs to PubMed abstracts[http://en.wikipedia.org/w/index.php?title=Stroke&diff=29501438&oldid=29278188]. I have reverted this. A casual reader can see this article has a references apparatus. I think it is rather poor form to use URLs in such a situation. If anyone thinks these studies are worth citing, please let me know so I can reinsert them in the form of actual references. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 23:00, 28 November 2005 (UTC)

== Smell of toast? ==

I was told that a person suddenly thinking that they smell toast is a sign of stroke. Any truth to this? --[[User:TheDoober|TheDoober]] 09:41, 19 December 2005 (UTC)

:A smell of toast? Sounds like an urban legend. Of course olfactory symptoms may indicate a problem in the frontal lobe, but toast? Nah. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 12:49, 19 December 2005 (UTC)

::I'm not so sure it's an urban legend. I once knew someone who had epilepsy and their warning sign for having a stroke was a strong smell of strawberries. They had 9 seconds after smelling this before they would blackout and start having a stroke. I would say it's certainly possible that the smell of toast is an indicator of an upcoming stroke, however as I just said toast is certainly not the only thing people may smell before they have one. If this information is added it would have to be more generic. [[User:VegaDark|VegaDark]] 09:33, 24 December 2005 (UTC)

:::It was [http://en.wikipedia.org/w/index.php?title=Stroke&diff=32580977&oldid=32391528 added by an anon] today. I'm not sure if it should stay in, but it does seem to be a common urban legend, though. I [http://punclox.blogon.com/archives/000681.html found] [http://www.conclaveproject.org/members/7/archives/cat_scriptsstoriespoetry.php some] [http://forums.comicgenesis.com/viewtopic.php?p=612918&sid=15007aa78940e21202d7f5ed8a970656 web] [http://www.b3ta.com/newsletter/issue111/ entries], [http://theotherandrew.blogspot.com/2005/12/thursday-five.html mostly] [http://themonkeyboylovescheese.mu.nu/archives/007728.php on] [http://experts.about.com/q/995/3628584.htm blogs]. It was also referenced on [http://www.twiztv.com/scripts/willandgrace/season1/willandgrace-102.htm an episode] of [[Will and Grace]] in 1998 ("WILL: Do you smell toast? Because I think you're having a stroke.") It's hard to search on PubMed or Google, because the [http://stroke.ahajournals.org/cgi/content/abstract/32/12/2735 TOAST criteria] for classifying strokes keeps getting in the way, but perhaps that acronym was a nod to the urban legend. --[[User:Arcadian|Arcadian]] 15:33, 24 December 2005 (UTC)

::::If we're revisiting symptoms, we might want to add [http://www.americanheart.org/presenter.jhtml?identifier=3008841 this]. --[[User:Arcadian|Arcadian]] 15:44, 24 December 2005 (UTC)

Blogs are a notoriously poor source of factual information, and I'd keep away from them. I think the American Heart guideline may be worthy of inclusion, but a good link to [[Barré test]] should be made, as it is effectively a variant of that. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 22:56, 25 December 2005 (UTC)

:I took out the toast thing. It is certainly not a cardinal symptom like hemiplegia or unilateral facial droop. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 23:28, 25 December 2005 (UTC)

Smelling burnt toast is a classic sign of an "Aura", a sign that someone is having a seizure, it's not known why, but although any olefactory hallucination can be a sign (but aren't required to have a seizure), burnt toast is common. I've seen it in patients before. [[User:216.48.168.68|216.48.168.68]] 11:50, 3 December 2007 (UTC)

See [[Wilder Penfield]] and this link [http://www.histori.ca/minutes/minute.do?id=10211] to a TV commercial. I don't know if it was based on a real case though. - [[User:Cybergoth|Cybergoth]] ([[User talk:Cybergoth|talk]]) 05:41, 24 January 2008 (UTC)

== Blabber ==

There was some random material interspersed into the article that is not very relevant to the general management of stroke:

:''Other studies are looking at the role of [[hypothermia]], or decreased body temperature, on [[metabolism]] and neuroprotection. Scientists are working to develop new and better ways to help the brain repair itself and restore important functions to stroke patients. Some evidence suggests that [[transcranial magnetic stimulation]] (TMS), in which a small magnetic current is delivered to an area of the brain, may possibly increase brain [[plasticity]] and speed up recovery of function after stroke.''

:''Recent research has shown that brain cells die after stroke by a signaling cascade using a protein called IKK2, presenting the possibility that cell death may be prevented by blocking this signaling [http://www.eurekalert.org/pub_releases/2005-11/embl-ltd110805.php].''

This can be reinserted somewhere else. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 16:51, 17 January 2006 (UTC)

== References ==
If people don't mind I would like to take out the references in plain parentheses ( #### ) and use standard wiki references templates with full references to the NIH medlib. [[User:Andrewr47|Andrewr47]] 02:47, 2 April 2006 (UTC)

:Please use cite.php. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 11:01, 2 April 2006 (UTC)

== merging [[cerebral hemorrhage]] & [[stroke]] ==

[http://www.emedicine.com/asp/dictionary.asp?keyword=cerebral+hemorrhage Cerebral hemorrhage] ''can'' (''not'' must) be a cause of a stroke. Aside from bleeding (hemorrhage), strokes can also be caused by ischemia (thrombotic stroke).

I removed the merge notice-- 'cause I think it is plainly based on a poor understanding of what a [http://www.emedicine.com/asp/dictionary.asp?exact=Y&keyword=stroke stroke][http://cancerweb.ncl.ac.uk/cgi-bin/omd?query=stroke&action=Search+OMD] (in the medical sense) is. [[User:Nephron|Nephron]] <small>[[User_talk:Nephron|&nbsp;T]]|[[Special:Contributions/Nephron|C]]</small> 02:31, 13 April 2006 (UTC)

:''Addendum'': The confusion arose 'cause the [[cerebral hemorrhage]] article was based on the (errant) assumption that ''cerebral hemorrhages'' and ''hemorrhagic strokes'' are the same thing. [[User:Nephron|Nephron]] <small>[[User_talk:Nephron|&nbsp;T]]|[[Special:Contributions/Nephron|C]]</small> 03:07, 13 April 2006 (UTC)

== Tissue plasminogen activator (tPA) ==

There is a discussion on Snopes.com (a website devoted to examining myths and urban legends) by Barbara Mikkelson, one of that site's principal contributors, that states: "...a new drug has been shown to limit disability from strokes caused by clots (ischemic) provided victims receive it within three hours of the onset of stroke symptoms. Tissue plasminogen activator (tPA) is a clot-busting drug administered intravenously in cases of ischemic stroke; however, only one in fifty stroke patients has a chance of this drug helping them because currently only 2 percent of them reach an emergency room in time for tPA to be given. (It's possible tPA's effectiveness can be boosted by simultaneous massaging of the clot with ultrasound. Early results from a 2004 study performed in Houston on coupling this drug with such treatment are most encouraging.)" (See http://www.snopes.com/medical/disease/stroke.asp).

At the time of writing (16 April 2006), tPA therapy is not mentioned in the Wikipedia discussion concerning strokes.

Can anyone shed any further light on the content and accuracy of the statements asserted in Snopes?

---EK

:[[Thrombolysis]] is mentioned. That's the same thing. There are different forms of rtPA available; use of these is called thrombolysis as a container term. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 08:14, 16 April 2006 (UTC)

==Pathophysiology==
I couldn't find anything about release of zinc ions being important in the pathogenesis of cerebral infarction, and so this was left out of the re-write. Matrix metalloproteases, which are usually dependent on zinc ions, are involved but are not activated by the introduction of zinc ions into to system per se. [[User:RFabian|RFabian]] 18:19, 16 May 2006 (UTC)

==Hereditary?==

Can someone please explain to me in more detail how a stroke can be hereditary? I've heard recently from the Heart & Stroke Foundation that those who suffer strokes at a young age increase their children's chances of stroke by 70%. My father was told he had a stroke because he was missing a nerve in his brain. My mother told me for all these years that stroke cannot be hereditary. Now, twenty years into life, I find out that chances are strong that I will have a stroke in my lifetime. My dad was thirty-five when he had his. Can someone please tell me if I should be worried? --[[User:RPaleja|RPaleja]] 06:04, 1 June 2006 (UTC)

== 131.227.76.238 UK edits in Ischemic stroke ==
131.227.76.238 made edits about the use of thrombolysis in the UK. They look like nonsense to me. Any views? [[User:Nunquam Dormio|Nunquam Dormio]] 06:46, 27 July 2006 (UTC)

==Reverted work==
I spent a lot of time editing this article to make it more clear and correct errors, and Renice changed much of it back to the original B- version. Too bad!<small>—Preceding [[Wikipedia:Signatures|unsigned]] comment added by [[User:E4043|E4043]] ([[User talk:E4043|talk]] • [[Special:Contributions/E4043|contribs]]) {{{2|}}}</small><!-- Template:Unsigned -->
:Your edit history[http://en.wikipedia.org/w/index.php?title=Special:Contributions&target=E4043] suggests you have made only one edit and that's your remark above. [[User:Nunquam Dormio|Nunquam Dormio]] 20:52, 7 September 2006 (UTC)

I just created a Wikipedia ID today, after having contributed to a few articles. I did my editing anonymously and I see that Wikipedia does not retroactively identify who you are. Anyway I can sign my prior work?<small>—Preceding [[Wikipedia:Signatures|unsigned]] comment added by [[User:E4043|E4043]] ([[User talk:E4043|talk]] • [[Special:Contributions/E4043|contribs]]) {{{2|}}}</small><!-- Template:Unsigned --> (signed and moved to bottom by [[User:Beetstra|Dirk Beetstra]] <sup>[[User_Talk:Beetstra|<span style="color:#0000FF;">T</span>]] [[Special:Contributions/Beetstra|<span style="color:#0000FF;">C</span>]]</sup> 21:42, 7 September 2006 (UTC))

:Your idea of 'clear' is my idea of 'simplistic' -- I don't think this article needs to talk down to anyone. I want more info, not less. For example, why is "Stroke symptoms start SUDDENLY," better than "Ischemic strokes usually only affect regional areas of the brain perfused by the blocked artery. Hemorrhagic strokes can affect local areas, but often can also cause more global symptoms due to bleeding and increased intracranial pressure."<br>

:Explaining your edits in the Edit Summary might help. Also use <nowiki>~~~~</nowiki> to sign your comments. --[[User:Renice|Renice]] 23:05, 7 September 2006 (UTC)

I'm sorry you're so defensive Renice. I felt that stating that strokes symptoms start suddenly as opposed to gradually is crucial information and very clinically relevant. As our readers can see from the very example you gave, my edited version is clear and yours is less so. Importantly, some of the other revisions I made corrected actual errors. Simple truths are better than fancy errors.

:I'm not defensive; you're just wrong. Complicated issues are not well served by over-simplification. For example, the symptoms of small hemorrhagic strokes can be so subtle that the patient hardly notices them until they get progressively worse -- in that way, one can say that the symptoms are ''progressive''. In which case 'SUDDENLY' in all caps (please.) is actually misleading. (And you still need to sign your posts.)--[[User:Renice|Renice]] 14:56, 8 September 2006 (UTC)

*If you're correcting 'actual errors' explain your edits and cite your sources. --[[User:Renice|Renice]] 15:07, 8 September 2006 (UTC)

*Further, since you seem to need another example, changing something like <font color=purple>"Often, patients complain of a sudden, extremely severe and widespread headache"</font> to <font color=darkred>"Often, patients complain of '''the worst headache of their life'''"</font> is not only grammatically incorrect, it's useless, as well as 'unencyclopedic'. --[[User:Renice|Renice]] 15:32, 8 September 2006 (UTC)

Renice -- truce!
*I'm sure you would agree that the textbook case of SAH involves a patient complaining of the "worst headache of my life". Every medical student knows that. And, it's very clinically relevant.
*Similarly, almost every acute stroke presents with the patient describing the sudden (SUDDEN) onset of his symptoms. I felt that these points need to be emphasized to the wikipedian audience because they are so clincally important.
*As far as an example of an actual error that I corrected, I see that you put back in:
"symptoms may include:

-muscle weakness (hemiplegia)

-numbness

-reduction in sensory or vibratory sensation"

I corrected that statement because numbness IS reduction in sensation -- they should not be separate bullets. And reduction in "sensory sensation" is redundant.

I'm new to how this works and I don't know how to retroactively sign my work, nor was I aware of the option to defend my changes in the discussion section. I will do so in the future. Thanks.

==Anonymous Removal of Alternate Perspective on tPA==
The data against the use of tPA in acute stroke was summarily deleted by an anonymous user. The use of tPA in acute stroke is highly controversial and although the AHA and AAN endorse it, the AAEM does not. Because of the controversy, it is important for both views to be presented in this Wikipedia segment. It is not appropriate for an anonymous editor to delete it. I would request from an administrator that anonymous deletions and editions not be allowed on this important and contentious topic. [[User:E4043|E4043]] 19:51, 19 October 2006 (UTC)

== cigarette smoking ==

Several times the article says cigarette smoking increases the risk of a stroke.
However, it isn't really clear, does it mean only cigarettes or just any form of smoked tobacco or even chewed tobacco?

:I suspect there may not be enough data to distinguish. Chewed tobacco also leads to absorption of the biochemical culprits in atheroma formation. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 11:05, 22 January 2007 (UTC)

== Bamford ==

In the UK much emphasis is placed on the 2000 Bamford classification[http://www.sbms.mvm.ed.ac.uk/bmto/neuroscience/NeuroSci4/sudlow/Bamfordsubtypesclassification_2000.pdf]. may be worthwhile including. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 11:03, 22 January 2007 (UTC)

== FAST Mnemonic ==

A search for the FAST mnemonic leads to the FAST disamb page, which directs readers here. There is nothing in the article about the mnemonic. Was it here at some time in the past and edited out through prior consensus, or is it an opportunity to upgrade the article? I don’t want to do the research required to add it the Symptoms section if you’ve already discussed and deleted it in the past as unreliable or non-notable. Thanks, [[User:12.96.58.21|12.96.58.21]] 19:00, 21 May 2007 (UTC) [[User:last1in|Kevin/Last1in]] posting without cookies

==Physical therapy==
Perhaps something about the general effectiveness of physical therapy could be added to the prognosis section? [[User:Adambiswanger1|AdamBiswanger1]] 03:41, 5 September 2007 (UTC)

== Please clarify ==

What is the problem at this point? I'm not sure I understand what part of the statements I added I need to work on and in what way?
Thank you <small>—Preceding [[Wikipedia:Signatures|unsigned]] comment added by [[User:StratedgeConsult|StratedgeConsult]] ([[User talk:StratedgeConsult|talk]] • [[Special:Contributions/StratedgeConsult|contribs]]) 01:48, 15 October 2007 (UTC)</small><!-- Template:Unsigned --> <!--Autosigned by SineBot-->

== HELP!! ==

Someone is disputing what I just added and I would like to know what part so I can fix it...

[[User:StratedgeConsult|StratedgeConsult]] 02:02, 15 October 2007 (UTC)

:You are adding non-standard treatments without suitable references. The University of Maryland Medical Center page is itself a summary of other studies, and it would be much more useful if you could add references directly to the research that supports the treatments you are writing about. Have a look at [[WP:NOR|original research]], [[WP:RS|reliable sources]], and perhaps also [[WP:WEIGHT|lending excessive weight to minority viewpoints]].
:Also, the tone of your contribution sounds more like a patient information leaflet than an encyclopedia ("This should not be attempted without consulting a physician as the choice of exercises will be very important.")
:It can be very difficult to write usefully about alternative medicine in this context. I think we need to explain carefully which treatments are ''popular'', and leave out those that have no popular support nor an evidence base. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 09:16, 15 October 2007 (UTC)

== Alternative medicine ==
Ah!, thank you for explaining! Now I know what to do to fix this. I am fairly new to using Wikipedia... it can be pretty frustrating to have your stuff removed without a constructive comment! So thank you and I will see what I can do to make it better.
[[User:66.108.20.63|66.108.20.63]] 14:34, 15 October 2007 (UTC)
I just looked again at the article I used and it is accredited by URAC:
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process . A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).
Is that not sufficient in terms of credibility and reliability? Just looking for guidance to make sure my contributions are worthy of WIKI!
Thx
[[User:66.108.20.63|66.108.20.63]] 14:57, 15 October 2007 (UTC)

:Please ''read'' the [[WP:RS]] before you ask. Extracts from WP:RS. "A reliable source is a published work regarded as trustworthy or authoritative in relation to the subject at hand. Evaluation of reliability will depend on the credibility of the author and the publication, ... the most reliable publications are peer-reviewed journals and books published in university presses; ...Academic and peer-reviewed publications are highly valued and usually the most reliable publications , such as ... ''medicine'' and science. " In medicine, you should stay with peer-reviewed work published in academic journals. Even there the quality isn't that high. The URAC you refer to is an INSTITUTIONAL health care accrediation which has nothing to do with the ACADEMIC quality of the knowledge presented. Your hospital may be accredited by a standards institution, but that does not mean the web pages are correct and that does definitelyu not mean that their web pages are reliable sources. [[User:Janbrogger|Janbrogger]] 15:59, 15 October 2007 (UTC)

===Types of stroke is incorrect===

This refers constantly to "ischemic" and "hemorrhagic" as the two types of strokes. This is misleading, in that ALL stroked are ischemic. That's the problem here, and why it's not just a subdural bleed. I'm putting this here in the discussion before I change anything, proposing that I change "ischemic" to the correct term "Occlusive". Occlusive is proper terminology (as far as the field of paramedecine regards it) [[User:Sirhodges|Sirhodges]] 01:57, 15 November 2007 (UTC)

:Paramedicine? Well, in practically all stroke publications the terms ischaemic and haemorrhagic are still used. You might be correct, but the literature uses these "incorrect" terms because they are more concerned with the primary clinical abnormality than with the pathophysiology. The Wikipedia page should therefore stick with the terminology in commission. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 18:15, 22 November 2007 (UTC)

==Bamford==
PMID 1675378 - we cannot NOT mention the 4 major stroke syndromes initially documented by Bamford et al in 1991. I will need to pull the paper if I want to cite it properly. [http://dok.org.uk/stroke_presentation.pdf This] presentation (by erstwhile editor {{user|Dokane}}) contains the usesful information too. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 18:15, 22 November 2007 (UTC)

:[http://www.rcplondon.ac.uk/pubs/books/stroke/stroke_guidelines_2ed.pdf RCP 2004 2nd ed stroke guidelines] - this will reflect the UK situation. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 16:25, 27 November 2007 (UTC)

:[http://www.americanheart.org/presenter.jhtml?identifier=3004586 AHA documents and guidelines] [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 16:26, 27 November 2007 (UTC)

:[http://www.acutestroke.org/ SITS trial - Safe implementation of thrombolysis in stroke] [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 16:30, 27 November 2007 (UTC)

:PMID 12917889 - Cochrane review of thrombolysis in stroke. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 16:53, 27 November 2007 (UTC)

:PMID 17687132 - a recent review on ischaemic stroke by prof Van Gijn. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 17:37, 27 November 2007 (UTC)

:PMID 16484610 - bedside examination of the "brain attack". [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 17:44, 27 November 2007 (UTC)

PMID 14568745 - if I can't get Van Gijn's paper, there always the last major review by the Edinburgh lot. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 00:10, 29 November 2007 (UTC)

== Cryptogenic stroke ==

{{DOI|10.1111/j.1538-7836.2008.02903.x}} - how hard are we looking for causes of stroke, and what can be done for the rarer/stranger causes? [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 10:32, 21 January 2008 (UTC)

==Collaboration==
I've just started reading this article. Except for an official section on "Causes" (which might be redundant), it looks pretty complete. What's the goal? I can find an hour this week to help, if you've got particular tasks in mind for the non-specialists. [[User:WhatamIdoing|WhatamIdoing]] ([[User talk:WhatamIdoing|talk]]) 04:56, 22 January 2008 (UTC)
:<s>I've noticed that some symptoms and treatment information is present in the introductory section to the article. Does anyone else agree that these should be moved to the individual sections? [[User:Cyclonenim|CycloneNimrod]] ([[User talk:Cyclonenim|talk]]) 01:00, 23 January 2008 (UTC)
::Oh, when I say move.. I actually mean delete as these are already in the individual sections. [[User:Cyclonenim|CycloneNimrod]] ([[User talk:Cyclonenim|talk]]) 01:06, 23 January 2008 (UTC)</s>

==First aid "diagnosis"==
I just killed the external link to a local-area-only nonprofit. It had information about the three-part first aid screening for stroke: smile, repeat a sentence, hold your arms over your head. This is appropriate information, I think, for our general audience. Where in the article does it belong? Symptoms? Diagnosis? A new section on first aid care? [[User:WhatamIdoing|WhatamIdoing]] ([[User talk:WhatamIdoing|talk]]) 19:35, 18 March 2008 (UTC)

== E.M.D.R. and Stroke ==

Has anyone seen evidence regarding the use of E.M.D.R. and recovery of short term memory in stroke victims?
[[User:Watson M.|Watson M.]] ([[User talk:Watson M.|talk]]) 08:52, 18 April 2008 (UTC)

:What is EMDR? Google? [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 05:58, 8 May 2008 (UTC)
E.M.D,R. (Eye Movement Desensitization and Reprocessing) is basically a way of allowing those with brain trauma for example post traumatic stress readapt to normal life. That is to say the ability to control the mind by allowing events to be placed in long term memory. [[User:Watson M.|Watson M.]] ([[User talk:Watson M.|talk]]) 08:55, 8 May 2008 (UTC)
::[[EMDR]], a not well supported psychology treatment. [http://www.skepdic.com/emdr.html]. Without a pubmed journal or other [[WP:MEDRS|medically reliable source]] it should not go on the page. [[User:WLU|WLU]] ([[User talk:WLU|talk]]) 10:27, 8 May 2008 (UTC)

==Mortality==
wat percent of people die from strokes and what might it come frim????i need to no because my brother had one yesterday and he is still in the hospitla im really horried/scared i dont know what to do please tell me some thingss!:(<nowiki><math>Insert non-formatted text here</math></nowiki> <small>—Preceding [[Wikipedia:Signatures|unsigned]] comment added by [[Special:Contributions/24.125.118.150|24.125.118.150]] ([[User talk:24.125.118.150|talk]]) 20:02, 25 April 2008 (UTC)</small><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

:Sorry nobody has responded to your message yet. This is more a question for the [[WP:RD|reference desk]]. Mortality from stroke depends on the type of stroke (lacunar versus partial/total anterior circulation stroke), and on the general condition of the patient (e.g. other concomitant illness). [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 05:58, 8 May 2008 (UTC)

== Magnesium ==

In an observational study higher levels of magnesium seem to have conferred a benefit. Not sure if there will be interventional trials, let alone which population they would choose for such an intervention http://archinte.ama-assn.org/cgi/content/abstract/168/5/459 [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 05:59, 8 May 2008 (UTC)

== C/E (what does that mean?) of my nutrition quote ==

Why was my quote cut out ([http://en.wikipedia.org/w/index.php?title=Stroke&diff=217250294&oldid=217246737 diff]? I don't agree with the change, which turned the text into an editor's POV rather than a reliable source's POV. [[User:ImperfectlyInformed|ImpIn]] | ([[User_talk:ImperfectlyInformed|t]] - [[Special:Contributions/ImperfectlyInformed|c]]) 06:29, 5 June 2008 (UTC)

: I agree and have restored it. Good call. -- <i><b><font color="004000">[[User:Fyslee|Fyslee]]</font></b></i> / <b><font color="990099" size="1">[[User talk:Fyslee|talk]]</font></b> 07:01, 5 June 2008 (UTC)

In that article, the authors' opinion on their colleagues' knowledge is the least important bit. They write the article ''because'' they want to inform physicians about the benefits of nutritional intervention. For the average reader of this Wikipedia article, it is much more important to mention the actual facts discussed in that article, namely that a Mediterranean diet can markedly reduce stroke risk. There is probably much else that can be quoted from that paper. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 09:19, 5 June 2008 (UTC)

:True. Good edit. [[User:ImperfectlyInformed|ImpIn]] | ([[User_talk:ImperfectlyInformed|t]] - [[Special:Contributions/ImperfectlyInformed|c]]) 09:25, 5 June 2008 (UTC)

I'm really glad we're in agreement about this. It is not unreasonable to mention some more of Spence's observations, as there is clearly evidence that good nutrition stops people stroking. I don't think, however, that we should mention it at the top of all preventative measures, precisely for the reasons Spence states: nutrition is not on the agenda ''yet''. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 10:49, 5 June 2008 (UTC)

== "Silent stroke" - separate, here, or in Transient ischemic attack? ==

There is another condition called "silent stroke," which I would have put in, but I really didn't know ehere. Perhaps discussion might be better before running around changing things. Here are two links about it:

http://www.medterms.com/script/main/art.asp?articlekey=16286
http://www.medscape.com/viewarticle/482072

It doesn't seem to belong under TIA because it does damage brain tissue and has no symptoms, though some could argue it's more benign and simply a warning sign of major stoke. It could go here in this article becasue it's a stroke. Or, perhaps it deserves its own jubmect? I'm just not sure which is best.[[User:DTF955|Somebody or his brother]] ([[User talk:DTF955|talk]]) 14:59, 19 July 2008 (UTC)

:If it causes no symptoms it will be impossible to detect without screening. More commonly, the symptoms are very subtle and all that happens is stepwise general deterioration, with the end result being [[vascular dementia]]. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 11:31, 25 July 2008 (UTC)

==CG68==
{{NICE|68|Stroke|2008}} - this is interesting and needs mentioning (as well as the American Guidelines of course). [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 11:31, 25 July 2008 (UTC)

:We are currently not discussing "malignant MCA syndrome", its catastrophic consequences, and the role of decompressive craniotomy. The NICE guideline has some guidance on this scenario. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 20:09, 29 July 2008 (UTC)

:I have the recent ''Lancet'' review sitting in my tray at work but keep on forgetting to take it home. Someone please remind me!! [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 19:41, 4 September 2008 (UTC)

ROSIER scale features in the NICE guideline. It's actually quite recent: PMID 16239179. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 09:04, 7 September 2008 (UTC)

==Agenda for this article==
I have been developing an interest in stroke as part of my daily work. It was great to expand work on the rarer forms of stroke, namely [[subarachnoid hemorrhage]] and [[cerebral venous sinus thrombosis]], but I am pained that this present article is still a bit of a mess and certainly needs a better plan. I have found the recent ''Lancet'' review ({{DOI|10.1016/S0140-6736(08)60694-7}}) of very high quality, and perhaps it could serve as a guide to other recent reviews and studies; most usefully it contains a list of proven and not-yet-proven treatments, as well as the [[number needed to treat]] for common stroke interventions. It certainly puts things in perspective.

I think the following things need to happen here:
* Ensure that all sections are compliant with [[WP:MEDMOS]]
* Ensure that all content is relevant in its context and well sourced to [[WP:MEDRS]]-compliant sources (i.e. we ought to drop the NINDS "hope through research" reference because it is itself not peer-reviewed or referenced)
* Ensure that less relevant content is split off to useful and topical sub-articles
* Ensure that cultural and historical content is well-sourced, relevant and reliable

Within the next few weeks I hope to start work here. I will be reviewing the ''Lancet'' review, the NICE guideline and any non-UK publications that might be relevant. Anyone who is willing to help is warmly invited. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 19:41, 4 September 2008 (UTC)
:Damn it, don't have access to The Lancet. Anyone willing to commit fraud, or a copyright violation? Or do I have to buy the article for a one-off? —'''[[User:Cyclonenim|Cyclonenim]]''' ([[User talk:Cyclonenim|talk]] · [[Special:Contributions/Cyclonenim|contribs]] · [[Special:EmailUser/Cyclonenim|email]]) 14:32, 7 September 2008 (UTC)

I have no digital access; my copy of that review was made under my employer's license at a hospital library. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 20:01, 7 September 2008 (UTC)
:No worries, [[WP:WRE]] is absolutely fantastic. A user managed to provide me with a copy in just under a day! —'''[[User:Cyclonenim|Cyclonenim]]''' ([[User talk:Cyclonenim|talk]] · [[Special:Contributions/Cyclonenim|contribs]] · [[Special:EmailUser/Cyclonenim|email]]) 16:25, 8 September 2008 (UTC)

If WRE is so fantastic, perhaps we should ask them for a hardcopy of Warlow ''et al'' 2008, that 1000 page book on Stroke by the cream of the UK neurovascular physicians. I tend to implicitly believe everything Peter Rothwell publishes, and that goes for most of his co-editors as well. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 13:57, 14 September 2008 (UTC)

==Reorganization of Therapy Section?==
I just added a brief mention of a new NEJM looking at thrombolysis with alteplase in the 3-4.5hr window after ischemic stroke. In re-reading the section, I think that it needs substantial revision. A few ideas:
* The distinction between treatments for acute stroke and stroke prophylaxis could be clearer.
* I don't think it's clear form the article that thrombolysis, mechanical thrombectomy, etc. are therapies for only ischemic stroke.
* Should the section on hypothermia be given less emphasis (possibly discussed last) compared to thrombolysis?


Thoughts?[[User:Wawot1|Wawot1]] ([[User talk:Wawot1|talk]]) 01:08, 24 September 2008 (UTC)

:Treatment is about treatment; secondary prevention belongs after treatment. Prophylaxis should be in a different section altogether.
:I agree that we need to be clear that thrombolysis is not a treatment for haemorrhagic stroke.
:Hypothermia is listed as "experimental" by the Donnan ''et al'' review - perhaps we should discuss it last, or possibly after that :-).
:Thanks for thinking along. This article deserves more. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 18:08, 24 September 2008 (UTC)

:http://content.nejm.org/cgi/content/short/359/13/1317 ECASS III extends thrombolysis window to 4.5 hours. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 23:11, 24 September 2008 (UTC)

I just undertook a reorganization/partial rewrite of the therapy section. Still needs more references, reorganization, rewriting, but I'm out of time for a while....[[User:Wawot1|Wawot1]] ([[User talk:Wawot1|talk]]) 02:27, 25 September 2008 (UTC)

== Ginko protected rats from 50%-65% of stroke damage ==

Suggest to add:


;Ginko biloba
In a study published in
on October 9, 2008, the researchers found that rats pre-treated with daily ginko biloba doses had only 50% of the post-stroke damage of untreated rats. Further, rats not previously treated but treated with ginkgo biloba within 5 minutes of the surgically-induced stroke had 65% less stroke damage. PMID 18845796<ref>Sofiyan Saleem PhD; Hean Zhuang MD; Shyam Biswal PhD; Yves Christen PhD; and Sylvain Doré PhD
'''Ginkgo Biloba Extract Neuroprotective Action Is Dependent on Heme Oxygenase 1 in Ischemic Reperfusion Brain Injury'''
'''Stroke''' October 2008

http://stroke.ahajournals.org/cgi/content/abstract/STROKEAHA.108.523480v1

Published Online on October 9, 2008

Published online before print October 9, 2008, doi: 10.1161/STROKEAHA.108.523480 </ref> <span style="font-size: smaller;" class="autosigned">—Preceding [[Wikipedia:Signatures|unsigned]] comment added by [[Special:Contributions/69.3.11.60|69.3.11.60]] ([[User talk:69.3.11.60|talk]]) 02:31, 12 October 2008 (UTC)</span><!-- Template:UnsignedIP --> <!--Autosigned by SineBot-->

:No, we have a longstanding policy not to discuss animal studies in great detail because the majority of treatments investigated in animals never makes it out of the lab and would clutter the article. I personally put the bar at phase III trials in rare diseases and formal approval in common diseases. [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 09:27, 12 October 2008 (UTC)

==Risk Factors==

The ability to deal with stress is an important factor when considering any pathology that comes down to thrombus/embolus formation. Im not really proficient enough to wiki to put in the references etc, so I though I'd leave a couple reference here and hope that someone would be kind enough to put it in.

Surtees PG, Wainwright NW, Luben RL, et al. Adaptation to social adversity is associated with stroke incidence: evidence from the EPIC-Norfolk prospective cohort study. Stroke 2007; 38:1447-1153

DeVries, A.C., Joh, H., Bernard, D., Hattori, K., Hurn, P.D., Traystman, R.J. and Alkayed, N. Social stress exacerbates stroke outcome by suppressing Bcl-2 expression. PNAS 2001; 98:11824-11828

([[User:BlackDice572|BlackDice572]] ([[User talk:BlackDice572|talk]]) 10:51, 11 May 2009 (UTC)).

:That is a primary source. Please provide a secondary source. In addition, could stress adaptability not be a confounder for other pathological changes? [[User:Jfdwolff|JFW]]&nbsp;|&nbsp;[[User_talk:Jfdwolff|<small>T@lk</small>]] 17:37, 11 May 2009 (UTC)

Revision as of 18:11, 21 May 2009

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