Published online by Cambridge University Press: 26 August 2009
Introduction: A stroke is not a ‘stroke’
Stroke cannot be considered a diagnosis in itself. Stroke refers to any damage to the brain or spinal cord caused by a vascular abnormality, the term generally being reserved for when symptoms begin abruptly. Stroke is anything but a homogeneous entity, encompassing disorders as different as rupture of a large blood vessel that causes flooding of the subarachnoid space with blood, the occlusion of a tiny artery supplying a small but strategic brain site and thrombosis of a venous conduit obstructing outflow of blood from the brain. Each stroke subtype carries with it different implications for acute treatment, prognosis and secondary prevention. Each stroke patient has additional variables that influence management, including the time from onset to presentation, the severity of the lesion, and associated comorbidities as well as social and psychological factors. The availability of non-invasive imaging techniques has revolutionized the diagnostic process, enabling a much greater understanding of the relevant pathophysiological processes active in the individual patient. This chapter provides an overview of how the specific diagnostic information available from non-invasive investigations can be applied to the management of individual patients.
‘Lumping’ vs. ‘splitting’
The goal of every clinician is to provide the best care for his or her patients.