ABSTRACT
A stroke is the result of direct or indirect interference with the blood supply to the brain. The number of cerebrovascular deaths annually in the United States is about 150,000, making stroke the third leading cause of death after heart disease and cancer. Approximately 700,000 new strokes occur each year, and 200,000 recurrent strokes are documented.[1] If the stroke is not fatal, rehabilitation of the majority of patients who have a permanent neurological deficit is protracted and costly. Thromboembolic disease accounts for the major cause of stroke[2] (Fig. 52-1), and carotid atherosclerosis is a direct cause of brain infarction in 10-20% of cases.[3] Although epidemiologic evidence has confirmed a 50% reduction in mortality rate from stroke over the last two decades (Fig. 52-2), neurologic deficits after stroke constitutes a major cause of disability among elderly Americans.[4] About 40% of the patients who survive required special nursing care and another 10% are disabled to such an extent that they need to be institutionalized. Approximately 2 million persons in the United States who have survived a stroke are alive. One can readily see how the acute and chronic care required by stroke victims consumes billions of dollars of the health care budget annually.
