Editorial
Throughout the course of history, there has been concern about the
impact of stroke on individuals, families and communities. Today,
despite a wealth of information on the cause, risk factors, prevention
and treatment strategies of stroke, the concern still prevails as stroke is
number one cause of disability in old age.
It was during the fourth century BC, when Hippocrates first named
the phenomenon of sudden onset of paralysis, loss of consciousness or
sudden death: ‘Apoplexy’ as in 'struck down violently'. He was the first
to approach scientifically what was then thought to be a ‘stroke of
God’s hand’. Hence, many of the basic terms for stroke and carotid
disease derive from ancient Greek medical literature [1]. Looking at
the evolution of the terminology, one could find the following:
• Apoplexy
• Cerebro Vascular Accident (CVA)
• Stroke
• Ischaemic Stroke
• Hemorrhagic Stroke
• Intracerebral Haemorrhage
• Brain Attack
Although scientists continued to study the cause, symptoms, and
treatment since the Hippocratic era, it was not until the mid-16th
century A.D. when the renaissance anatomists first differentiated and
concisely explained stroke pathophysiology in terms of blockage or
bleeding of a brain artery.
Later the term CVA was used but more recently was discouraged as
‘Accident’ implied partial fault of the patient. Ischaemic stroke or
stroke prevails to this day and both are medically correct and used
widely by the public.
Other related expressions for stroke included ‘the stroke of fate’ and
the ‘the stroke of justice’ which both evoke a sense of wrongdoing and
justified divine punishment for human failings continued well into the
nineteenth century. Napoleon’s physician summed up the dreadful
curse of apoplexy as follows:
"A first attack, which is often slight, is a summons without costs; a
second, a summons with costs; but a third is an execution on the
person" [2].
Thus, the notion of ‘the third stroke kills’ prevails to this day among
the public.
The old-fashioned term ‘apoplexy’ is now rarely used in western
hospitals and the more descriptive ‘brain attack’ term is becoming
more common rarely used in the rest of the world. Yet, all these terms
define a condition known to afflict mankind dramatically since ancient
times.
In the western world mainly, the public’s awareness of stroke and its
treatment were not raised until the 1990’s, which is considered as the
‘Decade of the Brain’ . The combined efforts and deep interest of
specialists in the field led to a new perspective of the medical urgency
of the condition. Hence, the term ‘Brain Attack’ was coined, especially
in the USA, to denote the urgency of the situation, as equivalent to the
term ‘Heart Attack’ [3].