Stroke

"... 's part in the has drawn fire as a quixotic quest after the mirage of collective security through the , an allegedly utopian, or "Wilsonian," endeavor that traded vague dreams for harsh realities and derailed a more realistic settlement, which might have lasted. Worst of all, arguments about the political fight at home over the treaty and membership in the League have cast him as a stubborn, self-righteous spoiler who blocked reasonable compromise. That view of him has often overlooked or minimized one glaring fact: in the middle of this fight, he suffered a stroke that left him an invalid for his last year and a half in office. Wilson's stroke caused the worst crisis of presidential disability in American history, and it had a effect on him. Out of a dynamic, resourceful leader emerged an emotionally unstable, delusional creature."

"Stroke versus TIA? s (TIA) occur in approximately 15% of patients before an eventual stroke, with the highest risk in the first days following an event ... While TIAs do not always come to medical attention, their presentation in the acute stroke setting ostensibly complicates the treatment decision in patients who may be exhibiting improvement. The majority of TIAs resolve in less than 60 minutes whereas the majority of true strokes reach peak deficit in the same time frame. A 2009 scientific statement from the / discourages the use of traditional time-based definitions of TIA in favor of a tissue-based definition (i.e. the presence or absence of lesions on diffusion-weighted ) ..."

"Our stroke expert, Sarah Song, MD, MPH, assistant professor of neurology at in Chicago, offers this valuable advice. Act FAST. Being able to recognize the signs of stroke will help you respond faster and get help sooner and may result in less disability, says Dr. Song. "Remember the acronym FAST: Face, Arm, Speech, Time," she says. "The face can droop on one side. The arm can be weak or numb. Speech can be garbled, slurred, or nonsensical. Time is of the essence." If you notice any of these symptoms in yourself or anyone else, call 911 and get to the hospital as quickly as possible. "Treatment for stroke is most effective for patients who arrive at the hospital within four and a half hours of the start of symptoms," says Dr. Song. Always call 911. "Some people think they should drive to the emergency department," says Dr. Song. But stroke units in hospitals across the country now work closely with first responders, she says. EMTs are trained to spot the signs of stroke and can connect patients with stroke doctors quickly to prevent long waits in waiting rooms and emergency triage. "Calling 911 is the single best way to get yourself or someone you love evaluated and treated for stroke," she says."

"(AF) is associated with an increase in mortality and morbidity, with a substantial increase in stroke and systemic . Strokes related to AF are associated with higher mortality, greater disability, longer hospital stays, and lower chance of being discharged home than strokes unrelated to AF."

"... The results of the European Cooperative Acute Stroke Study III (ECASS III) ... (ClinicalTrials.gov number, NCT00153036), reported in this issue of the Journal, teach us many lessons, some medical and some political, and clearly provide powerful, persuasive evidence that is safe and effective for patients with acute stroke. … The rationale for ECASS III arose from a pooled analysis of several previous studies that had differing time windows for enrollment. ... Analyses from the resulting pooled sample suggested that thrombolytic therapy could be beneficial even when given more than 3 hours after the onset of symptoms, and ECASS III was designed to confirm this hypothesis. As the authors of this article point out, however, neither their results nor those of the previous pooled analysis suggest that the ideal window for acute thrombolytic therapy is 4.5 hours after the onset of a stroke, because we know that the potential for neurologic rescue declines monotonically with every passing minute. ... I like to pose this scenario to my trainees: a patient presents to you 30 minutes after the onset of a left hemispheric stroke; how long do you have to initiate thrombolytic therapy? The correct answer is 1 minute, not 2.5 hours, and ECASS III does not now justify an answer of 4 hours. From the moment the patient arrives at the door, every minute counts ..."

"What is a stroke? ... how common is it? It is the leading cause of serious disability of adults in the United States. It is the fifth leading cause of deaths in the United States. Moreover, it is the second leading cause of deaths worldwide ... it is characterized by injury to the brain from or rupture of a . There are two broad types of stroke. The first is blockage of a blood vessel — that accounts for eighty percent of strokes ... And there's , which accounts for twenty percent ... due to rupture of a blood vessel."