A program of the American Academy of Neurology
The AAN Acute Stroke Management courses are supported in part by unrestricted educational grants from Abbott Laboratories, Genentech,
Inc., Janssen Pharmaceutical, and Wyeth-Ayerst Pharmaceutica .

• Review management of patients with acute stroke.
 Diagnosis
 Treatment of ischemic stroke
 Treatment of hemorrhagic stroke
• Review in-hospital management.
• Review management to prevent stroke or recurrent stroke.

• Third leading cause of death in the United
States
• Common cause of disability and long-term institutionalized care
• Economic consequences more than $40 billion annually
• Affects not only the patient but the entire family

• WHO – increased importance of stroke during next 50 years
 Developing countries
 Industrial societies including U.S.
• Decline in stroke incidence to be reversed
• Increase due to aging of population
• People who survive severe heart disease at high risk

• Advancing age is the premier predictor of stroke
– Stroke is an important cause of death in children
– Strokes are relatively common in young adults
• More women die from stroke than do men
• More women die from stroke than from cancer of breast
• Stroke accounts for 10% of maternal deaths during pregnancy or the peripartum period

• Under the age of 45, more women die from stroke than from heart attack
• Approximately 60% of patients with SAH are women
• Atrial fibrillation is an important risk factor for stroke among women older than 75

STROKE IN MINORITIES
Survey of Stroke Mortality in Texas
Rate-Ratio in Comparison to Non-Hispanic Whites
African-American
Hispanic American
Age
45-59
60-74
75+
45-59
60-74
75+
Men Women
4.06
2.57
3.22
2.31
1.26
1.73
1.09
0.77
1.10
1.30
1.07
0.63
Morgenstern et al
Stroke, 1997, 28:5-18

• HEMORRHAGIC STROKE – 20% of cases
– Subarachnoid hemorrhage
– Intracerebral hemorrhage
• ISCHEMIC STROKE – 80% of cases
– Large artery atherosclerosis
– Cardioembolism
– Small artery occlusion (lacunes)
– Non-atherosclerotic vasculopathies
– Hypercoagulable state

MANAGEMENT OF CEREBROVASCLAR DISEASE
• Treatment of risk factors in large populations
• Treatment of highest risk persons
• Management of acute stroke
• Prevention and treatment of medical and neurological complications
• Rehabilitation
• Prevention of recurrent stroke

• Hypertension
• Smoking
• Hypercholesterolemia
• Hyperhomocysteinemia
• Diabetes mellitus
• Alcohol abuse
• Drug abuse
• Co-developing heart disease

• Oral anticoagulants
• Antiplatelet agents
– Aspirin
– Aspirin and dipyridamole
– Clopidogrel
– Ticlopidine

• Carotid endarterectomy
• Extracranial/intracranial bypass
• Other reconstructive operations
• Angioplasty and stenting
• Cardiovascular operations

• Medical and surgical interventions lower risk of stroke, but they do not eliminate stroke entirely
• Some patients have a stroke as their first symptom
• Some causes of stroke are not amenable to preventive therapies

• The causes and effects of acute stroke (brain attack) are similar to those that cause acute myocardial ischemia (heart attack)
• Secondary to arterial diseases and lifethreatening
• Potential for serious medical or neurological complications
• Mandate emergent interventions to limit effects
• Can be treated successfully and improving outcomes

Components of Modern Management
 Prompt recognition
 Call 911 or seek attention
 Speedy transport (EMS)
 Rapid evaluation
 Urgent treatment

Pre and Post Course
Self Assessment
Goal: To assess patterns of physician behavior change as a result of attending the AAN Acute Stroke Management Course.
This goal will be achieved by measurement of knowledge at the following intervals: at the beginning of the course; at the end of the course; six months after the course.
1.
Pre Course Self Assessment
• 8:40 AM – 9:00 AM
Complete pre course self assessment
AAN staff will pick-up
2.
Post Course Self Assessment
• 4:10 PM – 4:30 PM
Complete post course self assessment
AAN staff will pick-up
3.
Six-month follow-up
• Assessment tool sent to all participants 6 months after the course