Talk:Stroke

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The original text for this article was taken from the public domain resource at http://www.ninds.nih.gov/health_and_medical/disorders/stroke.htm

Some people think that ischemic stroke is caused by excessive calcium ions triggered by lack of enough blood circulation. [1]
Yeah, the role of calcium in excitotoxicity is very well supported. This topic is treated in ischemic cascade. --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?

Contents

[edit] 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 (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. -- PFHLai 08:53, 2005 Mar 2 (UTC)
Cerebral hemorrhage now redirects here. 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? --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. 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 --81.174.140.179 21:27, 11 December 2006 (UTC)

[edit] 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.)

--Dubbin 17:51, 23 September 2005 (UTC)

[edit] Requested move

Add *Support or *Oppose followed by an optional one sentence explanation, then sign your vote with ~~~~
  • Support. But you might want to also post the suggestion at Wikipedia:Requested moves. --Arcadian 19:55, 23 September 2005 (UTC)
  • Neutral. 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. JFW | T@lk 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 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. David Rubentalk 00:19, 1 October 2005 (UTC)

[edit] Discussion

Add any additional comments
  • Re oppose - as I understand things, the WikiProject Clinical medicine has generaly tended to use the technical rather than the lay term. Hence the agreement over Myocardial infarction, with Heart Attack having the redirection. What are we going to do with Transient ischemic attacks, start naming the article "Mini-strokes" ? - David Rubentalk 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. - David Rubentalk 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. JFW | T@lk 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. --Dubbin 23:45, 1 October 2005 (UTC)
    • Dubbin, could you support this with professional society position documents etc etc? This would be immensely helpful. JFW | T@lk 23:49, 1 October 2005 (UTC)
      • Off the top of my head, try [2] - 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. --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. --Dubbin 23:52, 1 October 2005 (UTC)

[edit] Discision

Page moved. Ryan Norton T | @ | C 01:47, 15 October 2005 (UTC)

[edit] PubMed links

128.248.65.105 (talk • contribs) added some URLs to PubMed abstracts[3]. 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. JFW | T@lk 23:00, 28 November 2005 (UTC)

[edit] Smell of toast?

I was told that a person suddenly thinking that they smell toast is a sign of stroke. Any truth to this? --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. JFW | T@lk 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. VegaDark 09:33, 24 December 2005 (UTC)
It was 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 found some web entries, mostly on blogs. It was also referenced on 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 TOAST criteria for classifying strokes keeps getting in the way, but perhaps that acronym was a nod to the urban legend. --Arcadian 15:33, 24 December 2005 (UTC)
If we're revisiting symptoms, we might want to add this. --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. JFW | T@lk 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. JFW | T@lk 23:28, 25 December 2005 (UTC)

[edit] 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 [4].

This can be reinserted somewhere else. JFW | T@lk 16:51, 17 January 2006 (UTC)

[edit] 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. Andrewr47 02:47, 2 April 2006 (UTC)

Please use cite.php. JFW | T@lk 11:01, 2 April 2006 (UTC)

[edit] merging cerebral hemorrhage & stroke

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 stroke[5] (in the medical sense) is. Nephron  T|C 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. Nephron  T|C 03:07, 13 April 2006 (UTC)

[edit] 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. JFW | T@lk 08:14, 16 April 2006 (UTC)

[edit] 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. RFabian 18:19, 16 May 2006 (UTC)

[edit] 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? --RPaleja 06:04, 1 June 2006 (UTC)

[edit] 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? Nunquam Dormio 06:46, 27 July 2006 (UTC)

[edit] 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!—The preceding unsigned comment was added by E4043 (talk • contribs).

Your edit history[6] suggests you have made only one edit and that's your remark above. 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?—The preceding unsigned comment was added by E4043 (talk • contribs). (signed and moved to bottom by Dirk Beetstra T C 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."
Explaining your edits in the Edit Summary might help. Also use ~~~~ to sign your comments. --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.)--Renice 14:56, 8 September 2006 (UTC)
  • If you're correcting 'actual errors' explain your edits and cite your sources. --Renice 15:07, 8 September 2006 (UTC)
  • Further, since you seem to need another example, changing something like "Often, patients complain of a sudden, extremely severe and widespread headache" to "Often, patients complain of the worst headache of their life" is not only grammatically incorrect, it's useless, as well as 'unencyclopedic'. --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.

[edit] 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. E4043 19:51, 19 October 2006 (UTC)

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