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Keynote address

From the University of Rome, Rome, Italy.

Address correspondence and reprint requests to Dr. Cesare Fieschi, Department of Neurological Sciences, Viale dell’Università, 30, 00185 Rome, Italy.

"Acute strokes are here to stay": this could be the sad conclusion after decades of stroke research. Generalized prevention of ischemic stroke is not fully successful. After the decline in stroke incidence observed by 1970, partly related to better management of vascular risk factors, there has again been an increase in stroke frequency all around the world. This phenomenon may be explained by the lack of educational modalities for modification of lifestyle behavior, the small impact of high-risk individual prevention strategy, and the lack of rationale and guidelines for multiple approaches. In the meantime, the benefits of acute intensive management of stroke have been demonstrated. There is now considerable evidence that careful monitoring and management of general and cerebral functions in a dedicated stroke unit or by a specialized stroke team are superior to management in a neurologic or general ward. Currently, one way of optimizing limited personnel resources is to connect the stroke unit of a main hospital with peripheral hospitals via a computer network. Experts in the central stroke unit can then make on-line evaluations of CT and ultrasound examinations performed in the local hospital and recommend the best course of patient management. This new approach of treating stroke as an emergency will also require educational programs directed at the general public, general practitioners, and primary and emergency department physicians, to teach the recognition of stroke symptoms and the importance of treating stroke with the same urgency as for myocardial infarction (MI).