Introduction

Few conditions cause as much devastation to the human brain as stroke. The consequence of such damage ranges from being imperceptible to complete hemiparesis, a locked-in syndrome, reversal of personality, and, ultimately, death. In itself such a disease would be undesirable, but the common frequency of stroke makes it all the more feared. Stroke is the fourth commonest cause of death in the West, yet this simple statement belies the heavy toll inflicted on so many patients, families, friends, and careers. In the USA alone, more than 700,000 people suffer from stroke, but by the middle of this century, around 80% of the world’s burden will be in the emerging superpower nations of India and China (WHO Non-communicable diseases report). The pathophysiologic nature of the disease means that atherosclerosis in cerebral arteries is merely a symptomatic representation of the total burden of disease in the systemic arterial circulation. The result is that most stroke patients die of coronary artery disease and many also suffer from intermittent claudication from peripheral arterial disease. Stroke does not respect social class, creed, race, or religion. From the old rickshaw man in the slums of India, from US Ambassador Joseph Kennedy, Sir Winston Churchill occupying the highest offices of the land, to gangster Al Capone, stroke can inflict without notice. The disease has changed the course of human history when those occupying seats of power and making momentous decisions are struck down and replaced, famously as with Stalin and more recently with Israeli Prime Minister Ariel Sharon. And yet, perhaps the cruelest affront of all is when stroke afflicts the young. Around a quarter of strokes affect those under 65 years of age. This brings additional challenges to be addressed such as employment issues and emotional difficulties, as well as those associated with caring for young children. Being a vascular disease, a number of strategies are available to prevent first and recurrent ischemic stroke, ranging from lifestyle modifications (diet, exercise, and weight loss) to medications (antiplatelets, anticoagulants, statins, and antihypertensives).