1. Get Brain Smart!

3. Everything you ever wanted to know about stroke (but were afraid to ask) Timothy Lukovits, M.D.

4. stroke

9. Copyright restrictions may apply. Pancioli, A. M. et al. JAMA 1998;279:1288-1292. Respondents unable to name 1 warning sign or risk factor for stroke

14. MRI with diffusion weighted imaging Isolated weakness right index finger JS Kim, Neurology, 2002

15. Where is the stroke?

17. CT scan of arteries of neck and head

19. There are many potential causes of stroke

29. Kidwell 2004

35. 4:49 PM artery is opened

40. Improving Stroke Care at DHMC PREPARED INDIVIDUALIZED CARE PROTOCOLS TO DECREASE ERRORS A TEAM APPROACH RAPID EVALUATION

44. 10y risk 88% !

45. 10y risk 13% !

50. HJM Barnett 1999

51. Copyright restrictions may apply. Barnett, H. J. M. et al. Arch Neurol 2000;57:40-45. The medical and surgical 5-year Kaplan-Meier curves of freedom from ipsilateral stroke and perioperative stroke and death indicate a 5.9% difference favoring endarterectomy at 5 years in the Asymptomatic Carotid Atherosclerosis Study (ACAS)

52. Copyright ©2005 American Heart Association Alamowitch, S. et al. Stroke 2005;36:27-31 Kaplan-Meier 5-year risks of ipsilateral ischemic stroke for NASCET patients according to gender and degree of internal carotid artery stenosis in the medical and surgical groups

55. 18/111 (16%) received t-PA Average cost for transportation $4,623

56. 2004: 144 pts Rx t-PA 50% had t-PA started at 1 of 47 referring hospitals >50% of these have <60 beds

58. Meyer 2005

59. MGH TeleStroke

61. Schaebitz W-R, 2000

63. anticoag RG Hart 2003

64. Stroke Diagnosis 40 years ago

67. ABCD 2 Tool risk of stroke following TIA A Age> or = 60 1 B Blood pressure >140/90 1 C Clinical features unilateral weakness 2 speech impairment 1 D 2 Duration > 60 min 2 10-59 min 1 Diabetes 1

70. A B C D E F Systolic BP* 95-105 130-148 130-148 130-148 130-148 130-148 Diabetes No No Yes Yes Yes Yes Cigarettes No No No Yes Yes Yes Prior Atrial Fib. No No No No Yes Yes Prior CVD No No No No No Yes Estimated 10-year stroke risk in 55-year-old adults according to levels of various risk factors (FHS). Source: Wolf et al., Stroke.1991;22:312-318. *BP in millimeters of mercury (mmHg)

74. CT scan: ischemic stroke

75. Intracerebral hemorrhage at 1 hour and 6 hours

77. High resolution MRI to identify the unstable plaque Chu B, Circulation 2005

82. 11/30/06