Abstract
Hippocrates (460-377 BC) first described stroke over 2400 years ago. Stroke is the 4th leading cause of death in Canada (3rd in the USA) and the primary cause of permanent motor and cognitive disability. The majority of strokes are ischemic. The extent of cerebral dysfunction and thus the severity of stroke are based on the location, severity and duration of ischemia. Stroke management and prognosis encompass early recognition of the onset of stroke and post-stroke determination of the extent of brain injury aided by clinical stroke scores and diffusion-weighted imaging. Cognitive domains most likely to be affected following stroke are memory, orientation, language, attention and executive function. While the vast majority of functional recovery occurs within the first 3 months post-stroke, the neural mechanisms promoting recovery are not well understood. Investigations into the neural plasticity of brain areas after a lesion demonstrate that the adult brain can be shaped by environmental inputs, such as rehabilitation techniques. Many rehabilitation techniques are actively being pursued, including brain-computer interfaces providing sophisticated methods for detecting rehabilitation-associated changes in cerebral physiology. The success of such strategies visualized with functional magnetic resonance imaging and positron emission tomography may provide an objective complement to clinical evaluations.
Highlights
Stroke occurs following obstruction of blood flow and resultant neurological death to specific affected brain regions [1,2,3,4]
For example executive dysfunction 1 year post-Magnetic resonance imaging (MRI) was best predicted by diffusion tensor imaging (DTI), while DTI together with measures of brain volume, age, gender, and premorbid IQ, accounted for a large percentage (74%) of the executive function score variance in cerebral small vessel disease [30]
In elderly individuals with mild cognitive impairment, functional MRI (fMRI) scanning revealed that those who showed cognitive decline over the subsequent 2.5 year clinical follow-up; a significantly greater extent of the right parahippocampal area was activated during encoding, despite equivalent memory performance [76]
Summary
Stroke occurs following obstruction of blood flow and resultant neurological death to specific affected brain regions [1,2,3,4]. Brain attack, is the 4th leading cause of death in Canada (3rd in the USA) and the primary cause of permanent motor disability. Each year in the United States approximately 700,000 people over the age of 18 experience a new or recurrent episode; on average, 1 person has a stroke every 45 seconds [5]. In Europe deaths occurring from stroke average about 650,000 per year [7]. The average acute care stroke cost is approximately $30K per patient, leading to an annual cost of about $2.7 billion per year in Canada [8] and $64 billion annually in the United States [5,9]
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