More than 2,400 years ago the father of medicine, Hippocrates, recognized and
described stroke-the sudden onset of paralysis. Until recently, modern medicine
has had very little power over this disease, but the world of stroke medicine is
changing and new and better therapies are being developed every day. Today, some
people who have a stroke can walk away from the attack with no or few
disabilities if they are treated promptly. Doctors can finally offer
stroke patients and their families the one thing that until now has been so hard
to give: hope.
In ancient times stroke was called apoplexy,* a general
term that physicians applied to anyone suddenly struck down with paralysis.
Because many conditions can lead to sudden paralysis, the term apoplexy did not
indicate a specific diagnosis or cause. Physicians knew very little about the
cause of stroke and the only established therapy was to feed and care for the
patient until the attack ran its course.
The first person to investigate the pathological signs of apoplexy was Johann
Jacob Wepfer. Born in Schaffhausen, Switzerland, in 1620, Wepfer studied
medicine and was the first to identify postmortem signs of bleeding in the
brains of patients who died of apoplexy. From autopsy studies he gained
knowledge of the carotid and vertebral arteries that supply the
brain with blood. He also was the first person to suggest that apoplexy, in
addition to being caused by bleeding in the brain, could be caused by a blockage
of one of the main arteries supplying blood to the brain; thus stroke became
known as a cerebrovascular disease (“cerebro” refers to a part of the
brain; “vascular” refers to the blood vessels and arteries).
Medical science would eventually confirm Wepfer’s hypotheses, but until very
recently doctors could offer little in the area of therapy. Over the last two
decades basic and clinical investigators, many of them sponsored and funded in
part by the National Institute of Neurological Disorders and Stroke (NINDS),
have learned a great deal about stroke. They have identified major risk factors
for the disease and have developed surgical techniques and drug treatments for
the prevention of stroke. But perhaps the most exciting new development in the
field of stroke research is the recent approval of a drug treatment that can
reverse the course of stroke if given during the first few hours after the onset
Studies with animals have shown that brain injury occurs within minutes of a
stroke and can become irreversible within as little as an hour. In humans, brain
damage begins from the moment the stroke starts and often continues for days
afterward. Scientists now know that there is a very short window of opportunity
for treatment of the most common form of stroke. Because of these and other
advances in the field of cerebrovascular disease stroke patients now have a
chance for survival and recovery.
*Terms in Italics are
defined in the glossary.