Talk:Stroke/Archive 1

Original text
The original text for this article was taken from the public domain resource at http://www.ninds.nih.gov/health_and_medical/disorders/stroke.htm== Some == — Preceding unsigned comment added by 213.253.39.44 (talk) 07:42, 1 September 2002 (UTC)


 * Some people think that ischemic stroke is caused by excessive calcium ions triggered by lack of enough blood circulation.
 * Yeah, the role of calcium in excitotoxicity is very well supported. This topic is treated in ischemic cascade. --Delldot 15:49, 28 October 2005 (UTC)

this article needs to address some basic questions, incl:

Q. what is the average person's risk of stroke per year? what if they are a smoker?
 * http://www.theuniversityhospital.com/stroke/stats.htm

Cerebral hemorrhage
I just came across the cerebral hemorrhage article a little while ago. It seems that it used to be a redirect to this article, but isn't anymore (starting November 2004). Should it point here? &mdash;User:Mulad (talk) 05:04, Mar 2, 2005 (UTC)
 * I agree cerebral hemorrhage should merge with and redirect to Cerebrovascular accident. Cerebral hemorrhage is unlikely to have enough content to stand on its own without duplicating info already in cerebrovascular accident. -- PFHLai 08:53, 2005 Mar 2 (UTC)
 * Cerebral hemorrhage now redirects here. Alex.tan 06:53, August 11, 2005 (UTC)
 * I've added a whole bunch of information to hemorrhagic stroke so I thought it needed its own page. Stroke is already a little long and unruly, I think. Plus, hemorrhagic stroke is really different in mechanism, treatment, epidemiology, prognosis, and risk factors than ischemic.  I'd also like to take the treatment for hemorrhagic stroke from this article and into the hem stroke article, leaving a blurb. Let me know what you think.


 * Cerebral hemorrhage can be caused by brain trauma, and intracerebral hemorrhage has its own stub. Cerebral hemorrhage currently redirects to hemorrhagic stroke, but should it redifect to the stub with a link in the article to hemorrhagic stroke? --Delldot 15:49, 28 October 2005 (UTC)


 * Hemorrhagic stroke now points here. Cerebral hemorrhage has not been touched. Reason is ICH and SAH are two big topics that can't fit in cerebral hemorrhage anyways, hemorrhagic stroke was briefly added in stroke with ICH and SAH linked.


 * Original author of cerebral hemorrhage has authorized merge into stroke so I will redirect it soon if there's no objections. Andrewr47 22:38, 6 April 2006 (UTC)

"On average, a stroke occurs every 45 seconds and someone dies every 3 minutes." - I don't think that this is entirely relevant. -- Johnt --81.174.140.179 21:27, 11 December 2006 (UTC)

CVA should redirect to stroke
There is a growing consensus among neurologists researching and managing stroke, that the term "cerebrovascular Accident (CVA)" should be abandoned in favour of "stroke". The purpose of the change is to highlight the fact that stroke is not an "accident" like a lightning strike, but a treatable brain disorder with known and often preventable risk factors. This is especially true with the advent of thrombolysis and endovascular intervention for stroke.

I'd like to rejig the redirect so that Stroke is the main articla, and CVA and cerebrovascular accident redirect to it. There would also be a textual edit to reflect and possibly highlight the change.

Any thoughts?

(FWIW I am a neurogist at the National Hospital for Neurology and Neurosurgery, London, which includes University College London Hospitals NHS Trust Acute Brain Injury Unit.)

--Dubbin 17:51, 23 September 2005 (UTC)

Requested move

 * Add *Support or *Oppose followed by an optional one sentence explanation, then sign your vote with ~ 


 * Support. But you might want to also post the suggestion at Requested moves. --Arcadian 19:55, 23 September 2005 (UTC)
 * Neutral. I have not heard about the renaming, and I hear the terms being used interchangeably. I am willing to effect the move (which will involve deleting redirects) if consensus can be reached here. JFW | T@lk  16:42, 26 September 2005 (UTC)
 * Support Most neurologists I know favor stroke over CVA. It's also nice that it's a term well-known in the lay community InvictaHOG 06:17, 30 September 2005 (UTC)
 * Oppose (strong) The name by which all other doctors and the textbooks refer to is CVA, if this is seen as an unpleasant (un-PC) term for use by neurologist when talking to patients, then fine, but the technical term used in coding systems is still CVA. David Rubentalk 00:19, 1 October 2005 (UTC)
 * Oppose Some hospitals are trying to call these "Brain attacks" instead of "strokes"  but textbooks still refer to these as CVA's. The term "Stroke" is to "CVA" what "Heart attack" is to "Myocardial infarction" Sirhodges 02:01, 15 November 2007 (UTC)

Discussion

 * Add any additional comments


 * Re oppose - as I understand things, the WikiProject Clinical medicine has generaly tended to use the technical rather than the lay term. Hence the agreement over Myocardial infarction, with Heart Attack having the redirection. What are we going to do with Transient ischemic attacks, start naming the article "Mini-strokes" ?  - David Rubentalk 00:19, 1 October 2005 (UTC)
 * Also note that "stroke" has other meanings, normally therefore in WP "Stroke" would be a disambiguation page that links to amongst other things CVA, or "Stroke (medicine)" if you must. Unusually for WP, the current "Stroke" page has already reserved the medical use and there is a separate Stroke (disambiguation) page. Switching CVA to Stroke therefore risks others wishing to move it again and claim "Stroke" as the initial disambiguation page.  - David Rubentalk 00:19, 1 October 2005 (UTC)
 * As it is the most important use of the noun "stroke", all other terms are disambiguated from it. It is therefore an appropriate redirect. JFW | T@lk  23:49, 1 October 2005 (UTC)
 * Don't worry about "classification systems" and "other doctors". They'll learn that "CVA" is no longer the accepted term, just as they learned for "cretin", "insane" and "mongol". The change from CVA to "stroke" is neurologist-led, as is stroke medicine these days. Wikipedia should reflect the prevailing opinion within the appropriate specialty: in this case, neurology. And don't worry about "TIAs", either - when all stroke-like events are treated with thrombolysis or angioplasty within an hour of onset, this term will be defunct too. --Dubbin 23:45, 1 October 2005 (UTC)
 * Dubbin, could you support this with professional society position documents etc etc? This would be immensely helpful. JFW | T@lk  23:49, 1 October 2005 (UTC)
 * Off the top of my head, try - the British Association of Stroke Physicians' educational documents page. Every reference to the phenomenon uses "stroke" rather than "CVA". Among specialists dealing with this condition, the term CVA is long dead. --Dubbin 23:55, 1 October 2005 (UTC)
 * Citing "myocardial infarction" as the "technical" and therefore "correct" term argues against yourself: it is the name used by cardiologists, just as stroke is the term used among neurologists. "Stroke" also happens to have the advantage of being the commonly used lay term. --Dubbin 23:52, 1 October 2005 (UTC)

Discision
Page moved. Ryan Norton T 01:47, 15 October 2005 (UTC) Agree- The change should definitly be made. It's not about Lay terms vs. Technical terms, it's right vs. wrong. CVA is not the correct term anymore and this has been proven by neurologists. Stroke is not simply an "accident", but rather a condition for which the onset can be detected and prevented thanks to modern technology. I do agree that TIA should not change to "mini-strokes" however. The term Transient Ischemic Attack is more accurate than "mini-stroke", so it should remain as is. 192.251.46.22 (talk) 05:46, 5 March 2009 (UTC)

PubMed links
added some URLs to PubMed abstracts. I have reverted this. A casual reader can see this article has a references apparatus. I think it is rather poor form to use URLs in such a situation. If anyone thinks these studies are worth citing, please let me know so I can reinsert them in the form of actual references. JFW | T@lk  23:00, 28 November 2005 (UTC)

Smell of toast?
I was told that a person suddenly thinking that they smell toast is a sign of stroke. Any truth to this? --TheDoober 09:41, 19 December 2005 (UTC)


 * A smell of toast? Sounds like an urban legend. Of course olfactory symptoms may indicate a problem in the frontal lobe, but toast? Nah. JFW | T@lk  12:49, 19 December 2005 (UTC)


 * I'm not so sure it's an urban legend. I once knew someone who had epilepsy and their warning sign for having a stroke was a strong smell of strawberries.  They had 9 seconds after smelling this before they would blackout and start having a stroke.  I would say it's certainly possible that the smell of toast is an indicator of an upcoming stroke, however as I just said toast is certainly not the only thing people may smell before they have one.  If this information is added it would have to be more generic.  VegaDark 09:33, 24 December 2005 (UTC)


 * It was added by an anon today. I'm not sure if it should stay in, but it does seem to be a common urban legend, though. I found some web entries, mostly on blogs. It was also referenced on an episode of Will and Grace in 1998 ("WILL: Do you smell toast? Because I think you're having a stroke.") It's hard to search on PubMed or Google, because the TOAST criteria for classifying strokes keeps getting in the way, but perhaps that acronym was a nod to the urban legend. --Arcadian 15:33, 24 December 2005 (UTC)


 * If we're revisiting symptoms, we might want to add this. --Arcadian 15:44, 24 December 2005 (UTC)

Blogs are a notoriously poor source of factual information, and I'd keep away from them. I think the American Heart guideline may be worthy of inclusion, but a good link to Barré test should be made, as it is effectively a variant of that. JFW | T@lk  22:56, 25 December 2005 (UTC)


 * I took out the toast thing. It is certainly not a cardinal symptom like hemiplegia or unilateral facial droop. JFW | T@lk  23:28, 25 December 2005 (UTC)

Smelling burnt toast is a classic sign of an "Aura", a sign that someone is having a seizure, it's not known why, but although any olefactory hallucination can be a sign (but aren't required to have a seizure), burnt toast is common. I've seen it in patients before. 216.48.168.68 11:50, 3 December 2007 (UTC)

See Wilder Penfield and this link to a TV commercial. I don't know if it was based on a real case though. - Cybergoth (talk) 05:41, 24 January 2008 (UTC)

Blabber
There was some random material interspersed into the article that is not very relevant to the general management of stroke:


 * Other studies are looking at the role of hypothermia, or decreased body temperature, on metabolism and neuroprotection. Scientists are working to develop new and better ways to help the brain repair itself and restore important functions to stroke patients. Some evidence suggests that transcranial magnetic stimulation (TMS), in which a small magnetic current is delivered to an area of the brain, may possibly increase brain plasticity and speed up recovery of function after stroke.


 * Recent research has shown that brain cells die after stroke by a signaling cascade using a protein called IKK2, presenting the possibility that cell death may be prevented by blocking this signaling .

This can be reinserted somewhere else. JFW | T@lk  16:51, 17 January 2006 (UTC)

merging cerebral hemorrhage & stroke
Cerebral hemorrhage can (not must) be a cause of a stroke. Aside from bleeding (hemorrhage), strokes can also be caused by ischemia (thrombotic stroke).

I removed the merge notice-- 'cause I think it is plainly based on a poor understanding of what a stroke (in the medical sense) is. Nephron T|C 02:31, 13 April 2006 (UTC)


 * Addendum: The confusion arose 'cause the cerebral hemorrhage article was based on the (errant) assumption that cerebral hemorrhages and hemorrhagic strokes are the same thing. Nephron T|C 03:07, 13 April 2006 (UTC)

Tissue plasminogen activator (tPA)
There is a discussion on Snopes.com (a website devoted to examining myths and urban legends) by Barbara Mikkelson, one of that site's principal contributors, that states: "...a new drug has been shown to limit disability from strokes caused by clots (ischemic) provided victims receive it within three hours of the onset of stroke symptoms. Tissue plasminogen activator (tPA) is a clot-busting drug administered intravenously in cases of ischemic stroke; however, only one in fifty stroke patients has a chance of this drug helping them because currently only 2 percent of them reach an emergency room in time for tPA to be given. (It's possible tPA's effectiveness can be boosted by simultaneous massaging of the clot with ultrasound. Early results from a 2004 study performed in Houston on coupling this drug with such treatment are most encouraging.)" (See http://www.snopes.com/medical/disease/stroke.asp).

At the time of writing (16 April 2006), tPA therapy is not mentioned in the Wikipedia discussion concerning strokes.

Can anyone shed any further light on the content and accuracy of the statements asserted in Snopes?

---EK


 * Thrombolysis is mentioned. That's the same thing. There are different forms of rtPA available; use of these is called thrombolysis as a container term. JFW | T@lk  08:14, 16 April 2006 (UTC)

Pathophysiology
I couldn't find anything about release of zinc ions being important in the pathogenesis of cerebral infarction, and so this was left out of the re-write. Matrix metalloproteases, which are usually dependent on zinc ions, are involved but are not activated by the introduction of zinc ions into to system per se. RFabian 18:19, 16 May 2006 (UTC)

131.227.76.238 UK edits in Ischemic stroke
131.227.76.238 made edits about the use of thrombolysis in the UK. They look like nonsense to me. Any views? Nunquam Dormio 06:46, 27 July 2006 (UTC)

Reverted work
I spent a lot of time editing this article to make it more clear and correct errors, and Renice changed much of it back to the original B- version. Too bad! —Preceding unsigned comment added by E4043 (talk • contribs)
 * Your edit history suggests you have made only one edit and that's your remark above. Nunquam Dormio 20:52, 7 September 2006 (UTC)

I just created a Wikipedia ID today, after having contributed to a few articles. I did my editing anonymously and I see that Wikipedia does not retroactively identify who you are. Anyway I can sign my prior work? —Preceding unsigned comment added by E4043 (talk • contribs) (signed and moved to bottom by Dirk Beetstra T  C 21:42, 7 September 2006 (UTC))


 * Your idea of 'clear' is my idea of 'simplistic' -- I don't think this article needs to talk down to anyone. I want more info, not less. For example, why is "Stroke symptoms start SUDDENLY," better than "Ischemic strokes usually only affect regional areas of the brain perfused by the blocked artery. Hemorrhagic strokes can affect local areas, but often can also cause more global symptoms due to bleeding and increased intracranial pressure."


 * Explaining your edits in the Edit Summary might help. Also use ~ to sign your comments. --Renice 23:05, 7 September 2006 (UTC)

I'm sorry you're so defensive Renice. I felt that stating that strokes symptoms start suddenly as opposed to gradually is crucial information and very clinically relevant. As our readers can see from the very example you gave, my edited version is clear and yours is less so. Importantly, some of the other revisions I made corrected actual errors. Simple truths are better than fancy errors.


 * I'm not defensive; you're just wrong. Complicated issues are not well served by over-simplification. For example, the symptoms of small hemorrhagic strokes can be so subtle that the patient hardly notices them until they get progressively worse -- in that way, one can say that the symptoms are progressive. In which case 'SUDDENLY' in all caps (please.) is actually misleading. (And you still need to sign your posts.)--Renice 14:56, 8 September 2006 (UTC)


 * If you're correcting 'actual errors' explain your edits and cite your sources. --Renice 15:07, 8 September 2006 (UTC)


 * Further, since you seem to need another example, changing something like "Often, patients complain of a sudden, extremely severe and widespread headache" to "Often, patients complain of the worst headache of their life" is not only grammatically incorrect, it's useless, as well as 'unencyclopedic'. --Renice 15:32, 8 September 2006 (UTC)

Renice -- truce! "symptoms may include:
 * I'm sure you would agree that the textbook case of SAH involves a patient complaining of the "worst headache of my life". Every medical student knows that.  And, it's very clinically relevant.
 * Similarly, almost every acute stroke presents with the patient describing the sudden (SUDDEN) onset of his symptoms. I felt that these points need to be emphasized to the wikipedian audience because they are so clincally important.
 * As far as an example of an actual error that I corrected, I see that you put back in:

-muscle weakness (hemiplegia)

-numbness

-reduction in sensory or vibratory sensation"

I corrected that statement because numbness IS reduction in sensation -- they should not be separate bullets. And reduction in "sensory sensation" is redundant.

I'm new to how this works and I don't know how to retroactively sign my work, nor was I aware of the option to defend my changes in the discussion section. I will do so in the future. Thanks.

Anonymous Removal of Alternate Perspective on tPA
The data against the use of tPA in acute stroke was summarily deleted by an anonymous user. The use of tPA in acute stroke is highly controversial and although the AHA and AAN endorse it, the AAEM does not. Because of the controversy, it is important for both views to be presented in this Wikipedia segment. It is not appropriate for an anonymous editor to delete it. I would request from an administrator that anonymous deletions and editions not be allowed on this important and contentious topic. E4043 19:51, 19 October 2006 (UTC)

cigarette smoking
Several times the article says cigarette smoking increases the risk of a stroke. However, it isn't really clear, does it mean only cigarettes or just any form of smoked tobacco or even chewed tobacco?


 * I suspect there may not be enough data to distinguish. Chewed tobacco also leads to absorption of the biochemical culprits in atheroma formation. JFW | T@lk  11:05, 22 January 2007 (UTC)

Bamford
In the UK much emphasis is placed on the 2000 Bamford classification. may be worthwhile including. JFW | T@lk  11:03, 22 January 2007 (UTC)

FAST Mnemonic
A search for the FAST mnemonic leads to the FAST disamb page, which directs readers here. There is nothing in the article about the mnemonic. Was it here at some time in the past and edited out through prior consensus, or is it an opportunity to upgrade the article? I don’t want to do the research required to add it the Symptoms section if you’ve already discussed and deleted it in the past as unreliable or non-notable. Thanks, 12.96.58.21 19:00, 21 May 2007 (UTC) Kevin/Last1in posting without cookies

Physical therapy
Perhaps something about the general effectiveness of physical therapy could be added to the prognosis section? AdamBiswanger1 03:41, 5 September 2007 (UTC)

Please clarify
What is the problem at this point? I'm not sure I understand what part of the statements I added I need to work on and in what way? Thank you —Preceding unsigned comment added by StratedgeConsult (talk • contribs) 01:48, 15 October 2007 (UTC)

HELP!!
Someone is disputing what I just added and I would like to know what part so I can fix it...

StratedgeConsult 02:02, 15 October 2007 (UTC)


 * You are adding non-standard treatments without suitable references. The University of Maryland Medical Center page is itself a summary of other studies, and it would be much more useful if you could add references directly to the research that supports the treatments you are writing about. Have a look at original research, reliable sources, and perhaps also lending excessive weight to minority viewpoints.
 * Also, the tone of your contribution sounds more like a patient information leaflet than an encyclopedia ("This should not be attempted without consulting a physician as the choice of exercises will be very important.")
 * It can be very difficult to write usefully about alternative medicine in this context. I think we need to explain carefully which treatments are popular, and leave out those that have no popular support nor an evidence base. JFW | T@lk  09:16, 15 October 2007 (UTC)

Alternative medicine
Ah!, thank you for explaining! Now I know what to do to fix this. I am fairly new to using Wikipedia... it can be pretty frustrating to have your stuff removed without a constructive comment! So thank you and I will see what I can do to make it better. 66.108.20.63 14:34, 15 October 2007 (UTC) I just looked again at the article I used and it is accredited by URAC: A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch). Is that not sufficient in terms of credibility and reliability? Just looking for guidance to make sure my contributions are worthy of WIKI! Thx 66.108.20.63 14:57, 15 October 2007 (UTC)


 * Please read the WP:RS before you ask. Extracts from WP:RS. "A reliable source is a published work regarded as trustworthy or authoritative in relation to the subject at hand. Evaluation of reliability will depend on the credibility of the author and the publication, ... the most reliable publications are peer-reviewed journals and books published in university presses; ...Academic and peer-reviewed publications are highly valued and usually the most reliable publications, such as ... medicine and science. " In medicine, you should stay with peer-reviewed work published in academic journals. Even there the quality isn't that high. The URAC you refer to is an INSTITUTIONAL health care accrediation which has nothing to do with the ACADEMIC quality of the knowledge presented. Your hospital may be accredited by a standards institution, but that does not mean the web pages are correct and that does definitelyu not mean that their web pages are reliable sources. Janbrogger 15:59, 15 October 2007 (UTC)

Types of stroke is incorrect
This refers constantly to "ischemic" and "hemorrhagic" as the two types of strokes. This is misleading, in that ALL stroked are ischemic. That's the problem here, and why it's not just a subdural bleed. I'm putting this here in the discussion before I change anything, proposing that I change "ischemic" to the correct term "Occlusive". Occlusive is proper terminology (as far as the field of paramedecine regards it) Sirhodges 01:57, 15 November 2007 (UTC)


 * Paramedicine? Well, in practically all stroke publications the terms ischaemic and haemorrhagic are still used. You might be correct, but the literature uses these "incorrect" terms because they are more concerned with the primary clinical abnormality than with the pathophysiology. The Wikipedia page should therefore stick with the terminology in commission. JFW | T@lk  18:15, 22 November 2007 (UTC)

Bamford
- we cannot NOT mention the 4 major stroke syndromes initially documented by Bamford et al in 1991. I will need to pull the paper if I want to cite it properly. This presentation (by erstwhile editor ) contains the usesful information too. JFW | T@lk  18:15, 22 November 2007 (UTC)


 * RCP 2004 2nd ed stroke guidelines - this will reflect the UK situation. JFW | T@lk  16:25, 27 November 2007 (UTC)


 * AHA documents and guidelines JFW | T@lk  16:26, 27 November 2007 (UTC)


 * SITS trial - Safe implementation of thrombolysis in stroke JFW | T@lk  16:30, 27 November 2007 (UTC)


 * - Cochrane review of thrombolysis in stroke. JFW | T@lk  16:53, 27 November 2007 (UTC)


 * - a recent review on ischaemic stroke by prof Van Gijn. JFW | T@lk  17:37, 27 November 2007 (UTC)


 * - bedside examination of the "brain attack". JFW | T@lk  17:44, 27 November 2007 (UTC)

- if I can't get Van Gijn's paper, there always the last major review by the Edinburgh lot. JFW | T@lk  00:10, 29 November 2007 (UTC)

Cryptogenic stroke
- how hard are we looking for causes of stroke, and what can be done for the rarer/stranger causes? JFW | T@lk  10:32, 21 January 2008 (UTC)

Collaboration
I've just started reading this article. Except for an official section on "Causes" (which might be redundant), it looks pretty complete. What's the goal? I can find an hour this week to help, if you've got particular tasks in mind for the non-specialists. WhatamIdoing (talk) 04:56, 22 January 2008 (UTC)
 * I've noticed that some symptoms and treatment information is present in the introductory section to the article. Does anyone else agree that these should be moved to the individual sections? CycloneNimrod (talk) 01:00, 23 January 2008 (UTC)
 * Oh, when I say move.. I actually mean delete as these are already in the individual sections. CycloneNimrod (talk) 01:06, 23 January 2008 (UTC)

First aid "diagnosis"
I just killed the external link to a local-area-only nonprofit. It had information about the three-part first aid screening for stroke: smile, repeat a sentence, hold your arms over your head. This is appropriate information, I think, for our general audience. Where in the article does it belong? Symptoms? Diagnosis? A new section on first aid care? WhatamIdoing (talk) 19:35, 18 March 2008 (UTC)

E.M.D.R. and Stroke
Has anyone seen evidence regarding the use of E.M.D.R. and recovery of short term memory in stroke victims? Watson M. (talk) 08:52, 18 April 2008 (UTC)


 * What is EMDR? Google? JFW | T@lk  05:58, 8 May 2008 (UTC)

E.M.D,R. (Eye Movement Desensitization and Reprocessing) is basically a way of allowing those with brain trauma for example post traumatic stress readapt to normal life. That is to say the ability to control the mind by allowing events to be placed in long term memory. Watson M. (talk) 08:55, 8 May 2008 (UTC)
 * EMDR, a not well supported psychology treatment. . Without a pubmed journal or other medically reliable source it should not go on the page.  WLU (talk) 10:27, 8 May 2008 (UTC)

Mortality
wat percent of people die from strokes and what might it come frim????i need to no because my brother had one yesterday and he is still in the hospitla im really horried/scared i dont know what to do please tell me some thingss!:( $$Insert non-formatted text here$$ —Preceding unsigned comment added by 24.125.118.150 (talk) 20:02, 25 April 2008 (UTC)


 * Sorry nobody has responded to your message yet. This is more a question for the reference desk. Mortality from stroke depends on the type of stroke (lacunar versus partial/total anterior circulation stroke), and on the general condition of the patient (e.g. other concomitant illness). JFW | T@lk  05:58, 8 May 2008 (UTC)

Magnesium
In an observational study higher levels of magnesium seem to have conferred a benefit. Not sure if there will be interventional trials, let alone which population they would choose for such an intervention http://archinte.ama-assn.org/cgi/content/abstract/168/5/459 JFW | T@lk  05:59, 8 May 2008 (UTC)

C/E (what does that mean?) of my nutrition quote
Why was my quote cut out (diff? I don't agree with the change, which turned the text into an editor's POV rather than a reliable source's POV. ImpIn | (t - c) 06:29, 5 June 2008 (UTC)


 * I agree and have restored it. Good call. -- Fyslee / talk 07:01, 5 June 2008 (UTC)

In that article, the authors' opinion on their colleagues' knowledge is the least important bit. They write the article because they want to inform physicians about the benefits of nutritional intervention. For the average reader of this Wikipedia article, it is much more important to mention the actual facts discussed in that article, namely that a Mediterranean diet can markedly reduce stroke risk. There is probably much else that can be quoted from that paper. JFW | T@lk  09:19, 5 June 2008 (UTC)


 * True. Good edit. ImpIn | (t - c) 09:25, 5 June 2008 (UTC)

I'm really glad we're in agreement about this. It is not unreasonable to mention some more of Spence's observations, as there is clearly evidence that good nutrition stops people stroking. I don't think, however, that we should mention it at the top of all preventative measures, precisely for the reasons Spence states: nutrition is not on the agenda yet. JFW | T@lk  10:49, 5 June 2008 (UTC)

"Silent stroke" - separate, here, or in Transient ischemic attack?
There is another condition called "silent stroke," which I would have put in, but I really didn't know ehere. Perhaps discussion might be better before running around changing things. Here are two links about it:

http://www.medterms.com/script/main/art.asp?articlekey=16286 http://www.medscape.com/viewarticle/482072

It doesn't seem to belong under TIA because it does damage brain tissue and has no symptoms, though some could argue it's more benign and simply a warning sign of major stoke. It could go here in this article becasue it's a stroke. Or, perhaps it deserves its own jubmect? I'm just not sure which is best.Somebody or his brother (talk) 14:59, 19 July 2008 (UTC)


 * If it causes no symptoms it will be impossible to detect without screening. More commonly, the symptoms are very subtle and all that happens is stepwise general deterioration, with the end result being vascular dementia. JFW | T@lk  11:31, 25 July 2008 (UTC)

CG68
- this is interesting and needs mentioning (as well as the American Guidelines of course). JFW | T@lk  11:31, 25 July 2008 (UTC)


 * We are currently not discussing "malignant MCA syndrome", its catastrophic consequences, and the role of decompressive craniotomy. The NICE guideline has some guidance on this scenario. JFW | T@lk  20:09, 29 July 2008 (UTC)


 * I have the recent Lancet review sitting in my tray at work but keep on forgetting to take it home. Someone please remind me!! JFW | T@lk  19:41, 4 September 2008 (UTC)

ROSIER scale features in the NICE guideline. It's actually quite recent:. JFW | T@lk  09:04, 7 September 2008 (UTC)

Agenda for this article
I have been developing an interest in stroke as part of my daily work. It was great to expand work on the rarer forms of stroke, namely subarachnoid hemorrhage and cerebral venous sinus thrombosis, but I am pained that this present article is still a bit of a mess and certainly needs a better plan. I have found the recent Lancet review of very high quality, and perhaps it could serve as a guide to other recent reviews and studies; most usefully it contains a list of proven and not-yet-proven treatments, as well as the number needed to treat for common stroke interventions. It certainly puts things in perspective.

I think the following things need to happen here:
 * Ensure that all sections are compliant with WP:MEDMOS
 * Ensure that all content is relevant in its context and well sourced to WP:MEDRS-compliant sources (i.e. we ought to drop the NINDS "hope through research" reference because it is itself not peer-reviewed or referenced)
 * Ensure that less relevant content is split off to useful and topical sub-articles
 * Ensure that cultural and historical content is well-sourced, relevant and reliable

Within the next few weeks I hope to start work here. I will be reviewing the Lancet review, the NICE guideline and any non-UK publications that might be relevant. Anyone who is willing to help is warmly invited. JFW | T@lk  19:41, 4 September 2008 (UTC)
 * Damn it, don't have access to The Lancet. Anyone willing to commit fraud, or a copyright violation? Or do I have to buy the article for a one-off? —Cyclonenim (talk · contribs · email) 14:32, 7 September 2008 (UTC)

I have no digital access; my copy of that review was made under my employer's license at a hospital library. JFW | T@lk  20:01, 7 September 2008 (UTC)
 * No worries, WP:WRE is absolutely fantastic. A user managed to provide me with a copy in just under a day! —Cyclonenim (talk · contribs · email) 16:25, 8 September 2008 (UTC)

If WRE is so fantastic, perhaps we should ask them for a hardcopy of Warlow et al 2008, that 1000 page book on Stroke by the cream of the UK neurovascular physicians. I tend to implicitly believe everything Peter Rothwell publishes, and that goes for most of his co-editors as well. JFW | T@lk  13:57, 14 September 2008 (UTC)

Reorganization of Therapy Section?
I just added a brief mention of a new NEJM looking at thrombolysis with alteplase in the 3-4.5hr window after ischemic stroke. In re-reading the section, I think that it needs substantial revision. A few ideas:
 * The distinction between treatments for acute stroke and stroke prophylaxis could be clearer.
 * I don't think it's clear form the article that thrombolysis, mechanical thrombectomy, etc. are therapies for only ischemic stroke.
 * Should the section on hypothermia be given less emphasis (possibly discussed last) compared to thrombolysis?

Thoughts?Wawot1 (talk) 01:08, 24 September 2008 (UTC)


 * Treatment is about treatment; secondary prevention belongs after treatment. Prophylaxis should be in a different section altogether.
 * I agree that we need to be clear that thrombolysis is not a treatment for haemorrhagic stroke.
 * Hypothermia is listed as "experimental" by the Donnan et al review - perhaps we should discuss it last, or possibly after that :-).
 * Thanks for thinking along. This article deserves more. JFW | T@lk  18:08, 24 September 2008 (UTC)


 * http://content.nejm.org/cgi/content/short/359/13/1317 ECASS III extends thrombolysis window to 4.5 hours. JFW | T@lk  23:11, 24 September 2008 (UTC)

I just undertook a reorganization/partial rewrite of the therapy section. Still needs more references, reorganization, rewriting, but I'm out of time for a while....Wawot1 (talk) 02:27, 25 September 2008 (UTC)

Ginko protected rats from 50%-65% of stroke damage
Suggest to add:

In a study published in on October 9, 2008, the researchers found that rats pre-treated with daily ginko biloba doses had only 50% of the post-stroke damage of untreated rats. Further, rats not previously treated but treated with ginkgo biloba within 5 minutes of the surgically-induced stroke had 65% less stroke damage. —Preceding unsigned comment added by 69.3.11.60 (talk) 02:31, 12 October 2008 (UTC)
 * Ginko biloba


 * No, we have a longstanding policy not to discuss animal studies in great detail because the majority of treatments investigated in animals never makes it out of the lab and would clutter the article. I personally put the bar at phase III trials in rare diseases and formal approval in common diseases. JFW | T@lk  09:27, 12 October 2008 (UTC)

Risk Factors
The ability to deal with stress is an important factor when considering any pathology that comes down to thrombus/embolus formation. Im not really proficient enough to wiki to put in the references etc, so I though I'd leave a couple reference here and hope that someone would be kind enough to put it in.

Surtees PG, Wainwright NW, Luben RL, et al. Adaptation to social adversity is associated with stroke incidence: evidence from the EPIC-Norfolk prospective cohort study. Stroke 2007; 38:1447-1153

DeVries, A.C., Joh, H., Bernard, D., Hattori, K., Hurn, P.D., Traystman, R.J. and Alkayed, N. Social stress exacerbates stroke outcome by suppressing Bcl-2 expression. PNAS 2001; 98:11824-11828

(BlackDice572 (talk) 10:51, 11 May 2009 (UTC)).


 * That is a primary source. Please provide a secondary source. In addition, could stress adaptability not be a confounder for other pathological changes? JFW | T@lk  17:37, 11 May 2009 (UTC)

EFFECTIVE AND CURABLE OF STROKE
History Among the problem which face people age above 34 to 65 is a stroke about 14568 per year are effecte with problem. From the either in diry form or excessive of excercise within during resting time. From the estimation made in 2005 in Tanzania it give this figure.

Objectives

Occurance of stroke among the african people likely Tanzania and problem wil be created fom its problem.

Causes

This problem is caused by un proper feeding from 5to 25 age. Lessness created by expansion of adipose tissue. Un proper feeding of fat ,oil and some time starch occumulation of cellulose.

Preventive.

Control balance diet. Excercise is immediately aplied. Control eating of fat,oil and starch.

Effective.

From the demage of vein locate in to the brain head. Deposition of fat from the nerves. Exercieve of blood circulation on the veins. —Preceding unsigned comment added by 196.41.62.99 (talk) 09:18, 11 August 2009 (UTC)  —Preceding unsigned comment added by Enquire (talk • contribs)

Most important risk factor
The article states: "High blood pressure is the most important modifiable risk factor of stroke.[2]"

IIRC, smoking cessation produces a greater risk reduction than BP lowering. —Preceding unsigned comment added by 159.251.6.75 (talk) 17:27, 26 February 2010 (UTC)

Hereditary?
Can someone please explain to me in more detail how a stroke can be hereditary? I've heard recently from the Heart & Stroke Foundation that those who suffer strokes at a young age increase their children's chances of stroke by 70%. My father was told he had a stroke because he was missing a nerve in his brain. My mother told me for all these years that stroke cannot be hereditary. Now, twenty years into life, I find out that chances are strong that I will have a stroke in my lifetime. My dad was thirty-five when he had his. Can someone please tell me if I should be worried? --Anon. 06:04, 1 June 2006 (UTC)
 * Hi! As long as you don't ask for medical advice, but instead just want some clarification about heredity, you can ask a question at the WP:Reference desk/Science. Alternatively, book an appointment with your physician and ask her/him about it. Good luck!  Lova Falk     talk   08:37, 10 June 2010 (UTC)


 * Particular types of stroke can indeed be hereditary, although the majority of people with multiple strokes in one family will still have them because of "classical" risk factors (high blood pressure etc). Haemorrhagic stroke is sometimes caused by a hereditary amyloid angiopathy, more common in particular populations. There is no such thing as "missing a nerve" in the brain, and even that would not explain stroke risk.
 * With many hereditary diseases, there is not actually any treatment that would alter the disease (barring some important exceptions). The general advice that your doctor is likely to give is to make sure that you otherwise do not develop risk factors for stroke (high BP, diabetes, cholesterol, smoking) through a healthy lifestyle. JFW | T@lk  09:56, 10 June 2010 (UTC)

Paediatric Strokes
I was wondering why there is no reference to strokes in childhood. Perinatal stroke occuring during pregnancy and up till 1 month old 1 in 4,000. Later childhood strokes are rare however can be caused by blood clotting disorders, heart disease, chicken pox virus, blood vessel abnormalities and various other reasons. The chances of developing dystonia and epilepsey secondary to these strokes is higher than that of adults. —Preceding unsigned comment added by 121.219.55.236 (talk) 12:39, 6 October 2010 (UTC)

I moved this down so it would have it's own section and not get lost. As for the information itself, I think it would be a great addition as long as you have reliable sources that can verify it. If you're not sure how to add that info or format sources, feel free to post it here and I (or another editor) will be happy to help. Qwyrxian (talk) 21:20, 6 October 2010 (UTC)

Talk page too long, needs archiving
This talk page is way too long and needs archiving. I'm going to turn on Miszabot with a very high number of days (90) just to clear out the really old info. Qwyrxian (talk) 21:22, 6 October 2010 (UTC)

New prevention guidelines from heart and stroke
Here is the full text  Doc James  (talk · contribs · email) 17:02, 3 December 2010 (UTC)

number two cause of death worldwide?
2nd paragraph: "It is the leading cause of adult disability in the United States and Europe and it is the number two cause of death worldwide"

I've checked the paper "Stroke epidemiology in the developing world" but to me the above conclusion does not seem evident. Can someone doublecheck that this fact is actually backed-up? Thanks 212.41.115.191 (talk) 01:32, 18 December 2010 (UTC)

New information regarding persistence of inflamation, removed
An IP editor added three sentences, supported by a number of references, about the likelihood that persistent inflammation may remain in the stroke damaged area. User:Jfdwolff reverted that addition on what seemed to be very confusing grounds to me. First, Jfdwolff recommended less citations, a request that makes no sense to me, as 3 citations for critical lines doesn't seem like very much when trying to be accurate. Second, Jfdwolff said that it needed to be made clear why this is relevant; it seems clear to me that if there is good evidence suggesting that strokes cause persistent injury to the stroke penumbra that this is highly relevant, as it indicates a secondary problem caused by strokes. Personally, I think the information should be reinserted, but I'd rather discuss it here than just revert Jfdwolff. Qwyrxian (talk) 02:04, 22 February 2011 (UTC)


 * Per WP:BRD, it is sometimes easier to remove content temporarily and discuss its merits. Acute inflammation is probably a reaction to the ischaemia, but I'm much less certain about chronic inflammation. The references provided fall well short of the standards we expect; they would need to be high-quality secondary sources. There is no lack of such sources in this area of medicine, so I see no reason why we would need to rely on in vitro and rat studies.
 * I recall recent edits by new editor, who felt it necessary to add content about the use of Etanercept many months after the original stroke (used empirically in three patients). This is a continuation along the same pattern. Please examine the addition more closely before you come to its defence. JFW &#124; T@lk  07:09, 22 February 2011 (UTC)

The information has been reinserted, in agreement with Qwyrxian and Potionism. Progress in science and medicine is impeded by a failure to allow citation and discussion of new concepts (please see Paths to acceptance. The advancement of scientific knowledge is an uphill struggle against ‘accepted wisdom’. Wolinsky H. EMBO Rep. 2008 May;9(5):416-8, at http://www.nature.com/embor/journal/v9/n5/full/embor200865.html. The concept that chronic inflammation occurs in the stroke penumbra is supported by published scientific data from multiple academic centers, including some of the most prominent scientists in stroke research: see for example Neuroimage. 2010 Jan 1;49(1):19-31. Epub 2009 Aug 27. Mapping selective neuronal loss and microglial activation in the salvaged neocortical penumbra in the rat. Hughes JL, Beech JS, Jones PS, Wang D, Menon DK, Baron JC. Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK. The Kaushal reference (Kaushal V, Schlichter LC. Mechanisms of microglia-mediated neurotoxicity in a new model of the stroke penumbra. J Neurosci, 28(9), 2221-2230 (2008).) builds on previous work demonstrating the deleterious effects of microglial activation in the stroke penumbra and the validity of excess TNF as a therapeutic target. The utility of anti-TNF approaches for disorders of neuronal dysfunction associated with excess TNF is supported by accumulating data from diverse, independent academic centers; in addition to the Chio, Clark, Tobinick, Price, Kaushal, Walberer, and Pandya references please see Shi JQ, Shen W, Chen J et al. Anti-TNF-alpha reduces amyloid plaques and tau phosphorylation and induces CD11c-positive dendritic-like cell in the APP/PS1 transgenic mouse brains. Brain Res, 1368, 239-247 (2011); Park KM, Bowers WJ. Tumor necrosis factor-alpha mediated signaling in neuronal homeostasis and dysfunction. Cell Signal, 22(7), 977-983 (2010); Kato K, Liu H, Kikuchi S, Myers RR, Shubayev VI. Immediate anti-tumor necrosis factor-alpha (etanercept) therapy enhances axonal regeneration after sciatic nerve crush. J Neurosci Res, 88(2), 360-368 (2010); etc.

The key concept here is that the sum of this accumulating evidence from multiple academic centers is that TNF-mediated inflammation has been identified as a potential therapeutic target in stroke. This identification provides a new direction for scientific research. Wikipedia serves an important function by facilitating the identification and timely discussion of new advances in medicine such as this that are supported by independent, peer-reviewed scientific research. The fact that multiple, independent sources provide scientific support for this concept is not a shortcoming, rather it is a strength. If one reads the underlying references carefully the objective observer will conclude that the -631 edit should be reversed, as has been done. —Preceding unsigned comment added by 128.97.245.30 (talk) 10:34, 22 February 2011 (UTC)


 * This is obviously not widely accepted science. I have already made it very clear that it cannot be included into the article in the absence of reliable medical sources (MEDRS). I urge you to read the MEDRS document, because it explains my position. A "reliable medical source" is not every paper that has ever appeared in a medical journal; it should ideally be a high-quality review article. Also, not every avenue ever explored by medical research is automatically included on Wikipedia.
 * Please provide sources as requested before reinserting the same content again. JFW &#124; T@lk  14:26, 22 February 2011 (UTC)

The -631 edit violates Wikipedia policy by removing material correctly taken from reliable primary sources i.e. multiple, peer-reviewed published articles. The journals relied upon are respected journals: J Neurochem(Chio); Pharmacol Ther(Clark); J Neurosci(Kausal); Brain Research(Pandya); Stroke(Price); CNS Drugs(Tobinick); Exp Transl Stroke Med(Walberer). Please note Wikipedia policy: "....edits that rely on primary sources should only describe the conclusions of the source, and should describe these findings clearly so the edit can be checked by editors with no specialist knowledge. In particular, this description should follow closely to the interpretation of the data given by the authors, or by other reliable secondary sources. Primary sources should not be cited in support of a conclusion that is not clearly made by the authors or by reliable secondary sources, as defined above (see Wikipedia:No original research)." (emphasis added). Therefore it will be helpful to examine the statements by the original authors in the cited articles from these reliable scientific journals. Here are but a few:

from Price 2006: "Background and Purpose—Microglial activation is an important component of the neuroinflammatory response to ischemic stroke. Experimental studies have outlined such patterns temporally and spatially. In vivo studies in stroke patients have relied on positron emission tomography and (R)-PK11195, a ligand that binds peripheral benzodiazepine binding sites. In this study we sought to establish temporal and spatial patterns of microglial activation in ischemic stroke with particular emphasis on a defined peri-infarct zone. Methods—Using this technique, we studied carotid territory ischemic stroke patients in 3 time windows up to 30 days after ictus. Controls were studied in a single session. [11C](R)-PK11195 injection was followed by 3-dimensional acquisition over 60 minutes. Cerebral blood volume (CBV) was measured afterward with the use of standard C15O paradigms. Analysis employed the reference tissue model in which ipsilateral cerebellum was used to generate parametric binding potential maps corrected for CBV. Data were coregistered to T1-based MRI. Using control data to identify 99% confidence limits, a region of interest analysis was applied to identify significant binding in core infarction, contralateral hemisphere, and within a defined peri-infarct zone. Results—Four patients (mean age, 66 years) were imaged across 9 sessions. Four age-matched controls were studied. Within this model, ipsilateral cerebellum was validated as a reference tissue. With the use of control-derived confidence limits and correction for CBV, significant binding potential rises were identified beyond 72 hours and extending to 30 days in core infarction, contralateral hemisphere, and peri-infarct zone. Conclusions—In ischemic stroke patients, minimal activation of microglia is seen before 72 hours. Beyond this, binding potential rises in core infarction, peri-infarct zone, and contralateral hemisphere to 30 days. This may represent a therapeutic opportunity that extends beyond time windows traditionally reserved for neuroprotection."

from Kaushal 2008: "Specific molecules thought to trigger neuron death in the penumbra after a stroke include TNF-�, IL-1�, and reactive oxygen and nitrogen species (Sharp et al., 2000). Although studies of a single molecule cannot rule out involvement of multiple pathways, high TNF-� concentrations cause neuron apoptosis through a caspase-8-mediated pathway (Feuerstein et al., 1998; Gorman et al., 1998). TNF-� production increases after ischemia in vivo (Gabriel et al., 1999), and depleting TNF-� receptors can reduce neuron damage (Sriram et al., 2006). In the present in vitro penumbra model, we found that microglia activated by OGD-stressed neurons produced excess TNF-�, which contributed to killing naive, healthy neurons.....This is the first study linking microglial mGluRII with NF-�B signaling, and is especially important because NF-�B stimulates microglial production of TNF-� (Ginis et al., 2000)....the present in vitro study supports targeting microglial group II metabotropic receptors, TNF-� overproduction, and NF-�B for reducing inflammation-mediated neurotoxicity after ischemic stroke." (emphasis added).

from Walberer 2010: "By comparing macrosphere model, human stroke and tMCAO, key features of post-ischemic neuroinflammation, e.g. microglia activation, macrophages infiltration throughout the infarct and phagocytic accumulation, showed a similar temporal appearance in the macrosphere model in rats and human stroke, whereas tMCAO in rats leads to a rapid development of inflammation."

from Chio 2010: “Etanercept attenuated increased hippocampal levels of cellular hypoxia and damage markers during TBI…. Etanercept improved motor and cognitive function during TBI…. Antagonism of TNF-a with etanercept has proved to be effective in the treatment of acute spinal cord injury(Genovese et al. 2006) and centrally recombinant interleukin-1 or endotoxin-induced brain injury (Campbell et al. 2007). The present results further showed that systemic delivery of etanercept significantly improved outcomes of TBI in rats….the present study is valuable and provides scientific data that supports a potential therapeutic role of etanercept in TBI… In summary, the following behavioral, biochemical and histopathologic characteristics in the contusion brain were noted after TBI: (i) motor and cognitive dysfunction; (ii)cerebral ischemia and damage (evidenced by increased levels of cellular glutamate, lactate-to-pyruvate ratio and glycerol) (Chio et al. 2007; Kuo et al. 2007; Chen et al. 2009); (iii) cerebral contusion; (i.v.) systemic inflammation (evidence by increased levels of serum IL-1b, TNF-a and IL-6); (v) neuronal and glial apoptosis; and (vi) gliosis of both astrocytes and microglia. All these destructive characteristics were favorably influenced by etanercept therapy during TBI.”

from Tobinick Feb 1 2011: "The clinical effects of perispinal etanercept in these three patients provide pilot evidence that excess TNF is centrally involved in the pathogenesis of chronic neurological dysfunction following stroke....These results suggest that stroke may result in chronic TNF-mediated pathophysiology that may be amenable to therapeutic intervention long after the acute event."

from Pandya Feb 4 2011: "Our results have important implications for understanding the pathogenesis of cerebral ischemia, as influenced by a deleterious synergism between TNF and dysfunctional mitochondria. Brain levels of TNF rise within hours of ischemic cerebral injury, as inflammatory cytokines are released from activated microglia (Allan and Rothwell, 2001; Feuerstein et al., 1998). Cellular apoptosis induced by TNF is mediated through the generation of ROS (Shakibaei et al., 2005). Lacerda and colleagues showed that TNF stimulates ROS production in mitochondria (Lacerda et al., 2006). During ischemia, the hypoxia-dependent activation of the ROS-mediated apoptosis pathway is stimulated by TNF (Haddad and Land, 2001). In animal models of hypoxic-ischemic cerebral injury in neonates and of ischemic stroke in the developed human brain, a complex feedback cycle has been demonstrated to involve synergism between release of pro-inflammatory cytokines and ROS synthesis in mitochondria (Ali et al., 1999; Floyd, 1999; Ginsberg, 1998). Prior to this report, there has been no demonstration of a relationship between constitutive elevation of TNF and susceptibility of affected mitochondria manifested as premature mPT formation and loss of calcium buffering capacity. The present work is the first description of TNF-mediated, time-dependent mitochondrial dysfunction after cerebral ischemia…..Our observations also provide support for the role of the TNF -Tg rat as a clinically relevant model of cerebral ischemic injury in human stroke victims. Our transgenic animal shows robust elevation of TNF as an inflammatory response to focal cerebral ischemia (Pettigrew et al., 2008), replicating the same phenomenon in human brain (Tomimoto et al., 1996; Vila et al., 2000). The increased synthesis of TNF in the ischemic brain of the transgenic rat, compared to non-Tg controls, causes proportionately larger infarct volume, as was observed in human brain injured by stroke (Montaner et al., 2003; Zaremba et al., 2001)…. Our observations provide rationale for exploratory studies of therapeutic benefit in using mitochondrial protectants or modulators of TNF activity for the treatment of ischemic brain injury.” (emphasis added).

In addition, please note that the Clark 2010 review (Clark IA, Alleva LM, Vissel B. The roles of TNF in brain dysfunction and disease. Pharmacol Ther, 128(3), 519-548) is a respected secondary source as it is perhaps the most extensive (more than 500 references) published review of TNF and brain dysfunction across disease states. Since the three sentences that are the subject of this discussion are clearly supported by the published literature and their inclusion is supported by Wikipedia standing policy the -631 edit merits reversal. Please re-read the Qwyrxian comment; it makes eminent sense. —Preceding unsigned comment added by 128.97.245.218 (talk) 16:07, 22 February 2011 (UTC)


 * This "Pilot clinical evidence that perispinal administration of etanercept may reduce neurological dysfunction long after stroke and favorable effects of etanercept in animal models of traumatic brain injury suggest that TNF-mediated inflammation may represent a new therapeutic target in both stroke and traumatic brain injury" is tentative preclinical data. It may be okay on a page about Stroke research but does not belong here per WP:MEDRS and WP:DUE. Doc James  (talk · contribs · email) 16:22, 22 February 2011 (UTC)

The perispinal etanercept data from the CNS Drugs article is not "tentative preclinical data". It is published human data, supported by a wealth of experimental data as cited. It may, however, help to focus on the most important aspect of this: the identification of inflammation as a therapeutic target in stroke. This concept, that inflammation represents a therapeutic target in stroke worthy of investigation, is supported by all of the cited references and a wealth of additional literature. In a Wikipedia article that includes a section on things such as therapeutic hypothermia, exclusion of the concept of inflammation as a therapeutic target would be improper and not scientific. —Preceding unsigned comment added by 128.97.245.218 (talk) 16:33, 22 February 2011 (UTC)


 * On a large, well-researched subject like this, the results of a single, uncontrolled, non-randomized, open-label case series with n=3 is not WP:DUE. The results might be merely Hawthorne effect.
 * It might be possible to include a section about current areas of research (reducing inflammation being one of the biggest), but I'm not convinced that the previous efforts are the right way to go about such things.
 * (To the anon from UCLA: That CNS Drugs paper wouldn't happen to be yours, by any chance, would it?  You might want to read WP:SELFCITE.)  WhatamIdoing (talk) 16:46, 22 February 2011 (UTC)


 * 128.97, I think you are overstating the known benefits of your treatments. It all sounds very interesting, but so are numerous other investigational treatments that we are not currently mentioning. I urge you again to read WP:MEDRS, because failure to comply with this will lead to your additions being rejected.
 * I agree that the section on hypothermia was inappropriate. This has clearly never caught on. It is not mentioned by NICE guideline 68 (the British stroke guideline) or the 2008 Lancet review. I have removed it until better evidence of benefit and widespread use is available.
 * I share WhatamIdoing's concerns about promoting one's own work on Wikipedia. JFW &#124; T@lk  20:12, 22 February 2011 (UTC)


 * To suggest that "Wikipedia serves an important function by facilitating the identification and timely discussion of new advances in medicine such as this that are supported by independent, peer-reviewed scientific research" represents a complete failure to understand the purpose of our encyclopedia. On the contrary, Wikipedia is not the place to promote new theories. Wikipedia does of course report on advances in medicine that have been reviewed by reliable, independent, peer-reviewed secondary sources. It seems to me that the best way to move forward would be to examine Clark et al 2010 10.1016/j.pharmthera.2010.08.007, which appears to be a secondary source, and see how much weight they give to the theories. Then propose some wording at this page that can be accurately sourced to Clark. That would give the editors here some chance to reach consensus on whether the suggested text meets WP:DUE. --RexxS (talk) 21:05, 22 February 2011 (UTC)


 * The Pharmacology & Therapeutics is a pretty comprehensive review of TNF as a therapeutic target, but not directly mentions anti-TNF drugs. 10.1111/j.1471-4159.2010.06849.x examines neurogenesis in various CNS diseases, and similarly alludes to a role for TNF, as well as indication that TNF is detrimental in the acute phase post stroke. Neither of these reviews support the current claims. JFW &#124; T@lk  21:28, 22 February 2011 (UTC)


 * I just want to clarify my original point, as it was not so much support for the insertion of the material, as it was questioning why Jfdwolff. Specifically, I felt that the reasons given originally in his/her edit summary didn't make sense, and those reasons were 1) too many citations and 2) prove this is relevant.  I felt that having a lot of citations was not a detriment, and I also felt that it was relevant on the face of it, assuming the information was accurately reported and met WP:DUE.  Having said that, and having looked at the info a little more closely, I see that, in fact, the sources used are all primary sources, and not particularly "important" (in the sense of WP:DUE) ones at that.  If Jfdwolff had removed the material on the grounds that its sourcing violated WP:MEDRS, I would not have questioned the removal, and concur with the statements above by RexxS and JfdWolff—Wikipedia is absolutely not a site to disseminate new, breaking scientific (or, really, any) information.  That, in fact, is what scientific journals and, to a lesser extent, news media are for.  Particularly given the review articles that Jdwolff cites, which seem to indicate that this research is not currently widely accepted, I also agree the information should be left out until such time as it trickles down and finds its firmly embedded in the secondary sources that we always want to use. Qwyrxian (talk) 22:05, 22 February 2011 (UTC)


 * OK, that makes sense. I saw your exchange with Potionism on their talkpage also. Having heard this, I think the anonymous editor was probably wrong to regard your opinion as a mandate for reinserting the disputed content. JFW &#124; T@lk  22:20, 22 February 2011 (UTC)

Current areas of research
Do you think we could manage a decent, short section on the current areas of research? The NINDS says they're doing secondary insult (inflammation, glutamate excitotoxicity, edema), genetics and other risk factors, hypothermia and hibernation, and rehab. Are there other major areas that we're missing? WhatamIdoing (talk) 19:52, 23 February 2011 (UTC)


 * I think the body of the article could still be improved massively before we can even think about doing a "research directions" section. There is a lot of stroke research taking place. In the UK certainly it has finally come of age (possibly because of the "can-do" attitude of Rothwell in Oxford and the chaps in Edinburgh). Were we to start such a section, I think the best approach would be to use recent high-quality reviews rather than NINDS telling us what they are doing (which might be too limited). JFW &#124; T@lk  21:53, 23 February 2011 (UTC)

First Aid
I notice there is no first aid section for strokes. Seems like something pretty important that should be added. Livingston


 * What kind of first aid did you have in mind, apart from calling for medical help as soon as possible? JFW &#124; T@lk  23:51, 23 April 2011 (UTC)

Stroke rehabilitation
- this week's Lancet. JFW &#124; T@lk  15:05, 13 May 2011 (UTC)

Acupuncture on Stroke Rehabilitation
Some opinions said that acupuncture is effective in the recovery after a stroke, how true is this? — Preceding unsigned comment added by 60.49.220.170 (talk) 06:48, 25 October 2011 (UTC)

accupuncture can bring different results to different people, if it worked awesome, if not improved - not much is lost. Ltk59 (talk) 15:01, 25 November 2011 (UTC)

Duration of Recovery
Usually how long a person to recover from hemiplegia(what is the best example)? — Preceding unsigned comment added by 60.49.220.170 (talk) 07:03, 25 October 2011 (UTC)

Every case will be individualized, the question to be asked is if the person who has the condition corrected the reason they developed the hemiplegia Ltk59 (talk) 15:02, 25 November 2011 (UTC)

Merge Silent stroke
Should probably be merged here. Little content that is not covered here and currently a cotract.-- Doc James (talk · contribs · email) 16:07, 9 September 2011 (UTC)
 * I thought we were beyond the pettiness, slapping, a merge tag on the Silent stroke article just to be spiteful because I wrote it is not the type of behavior one would expect of an administrator and also a physician. The discussion on the Talk:Suicide page is obviously what precipitated this merge request. I made a rational argument to support my position on the suicide article which included references and said nothing disparaging against you, you made no attempt to support your position beyond a snide comment about the article not being a "patient tract". Silent stroke is not a "co-tract" to stroke because not everybody who has a silent stroke has a major stroke afterwards it also affects various population groups including young children with various hemoglobinopathies like Sickle cell disease (SCD). Approximately 7-8% of children with SCD suffer a stroke while up to 30% have silent stroke; there are also unique issues associated with silent stroke so it warrants a separate article. There was also no mention of silent stroke anywhere on Wikipedia until I wrote so there was no previous concern on your part about the content matter it and also the article is not complete so please be mature and not disrupt Wikpedia to prove a point. 7mike5000 (talk) 05:20, 10 September 2011 (UTC)


 * Mike, please assume good faith. I think it is entirely appopriate to consider the importance of merging the articles. The current silent stroke article is stuffed with primary sources, and I don't think a lot would remain if we removed everything that could not be backed up with WP:MEDRS-compliant sources.
 * Indeed, it makes more sense to split the content to multi-infarct dementia and stroke. A silent stroke is not a disease by definition. JFW &#124; T@lk  20:58, 10 September 2011 (UTC)


 * The merge tag was placed out of spite nothing more by User:Jmh649 who as you know is also an administrator which is not acting in good faith. The timing for this alleged concern is because I mentioned it on the Talk:Suicide page, I was trying to improve the article, he can't explain how an image which romantacizes suicide is appropriate for a article on suicide, so to be petty he puts the tag up. The article is not complete and the fact that it is "not a disease" does not dictate whether or not it warrants a separate article. Transient ischemic attack is also not a disease they are both "vascular events".
 * No offense because i'm not loking to get into it with someone else but people preach WP:MEDRS-compliant sources and yet do just the opposite and blatant medical misinformation or ommission of facts are a lot more egregious transgressions to the integrity of a medical resource than WP:MEDRS-noncompliant sources, the originally misnamed Hemoglobin Lepore syndrome comes to mind. The Silent stroke is not done because nobody else has bothered to contribute to it and I was under a restriction from mentioning the word "cognitive", which, cognitive deficits and emotional lability are major effects of silent stroke, so I have held off. Also as I previously mentioned there was no mention of silent stroke anywhere on Wikipedia at all, zero, which is an incredible oversight so I find the sudden concern over the topic circumspect and not in good faith. The fact that people are willing to interfere with valuable medical information available to a worldwide audience just to be petty and piss someone off is incredible, that the individual who precipitated this is a physician makes it more reprehensible so please do not preach to me about good good faith. 7mike5000 (talk) 22:08, 10 September 2011 (UTC)


 * Your language worries me. I see no evidence of "spite" or WP:POINT in Jmh649's actions. More likely, he looked at your contributions and saw the article you had been working on, and felt it would be better merged here. You really should not read too much into that, however easy it might be if you're sensitive to it. It is not relevant that James is a doctor or an administrator.
 * Nobody is suggesting that the content of silent stroke should disappear. I think I agree with James that it might be better to discuss the information in context. My personal view is that the current content needs stronger sources. JFW &#124; T@lk  23:10, 10 September 2011 (UTC)
 * I mentioned Silent stroke on the Talk:Suicide page within a few hours the image on the article is deleted, erroneously I might add and a merge tag appears that is a blatant example of WP:POINT. The fact that User:Jmh649 is an administrator is relevant because an administrator shoud be a little more mature and refrain from petty vindictiveness. Being a doctor is also relevant as they should place the welfare of others above their own egos. Silent stroke affects millions (11 million in the U.S. alone compared to 760,000 strokes), most people are not aware they have had one, Wikipedia presents the opportunity to disseminate that information. Silent stroke presents some unique challenges in addition to the fact that it is often undiagnosed, this is but one example:
 * "In one of the landmark studies examining the impact of silent stroke on neurocognitive functioning, Armstrong and colleagues (1996) found that children with SCD and a history of overt stroke had significantly lower neuropsychological scores than children withour silent strokes..."(Sam Goldstein, Cecil R. Reynolds: Handbook of Neurodevelopmental and Genetic Disorders in Children p.345)
 * If Wikipedia strives to be an informative and relevant medical resource it is hard to achieve that aim by deleting useful information or diminishing the quality of that information, just to exercise vindictiveness against one individual. An unwarranted merge would most definitely diminish the information on silent stroke as it is a separate vascular event. The article itself is by no means complete; it is an important medical topic, there was no mention of it on Wikipedia so I started the article and posted it in a truncated form, which while brief explains the basics. The article needs to be expanded, improved and as far as "current content needs stronger sources" I do not disagree. When the opportunity presents itself I will add to it in the meantime anyone is free to improve the article as I do not own it. 7mike5000 (talk) 02:35, 11 September 2011 (UTC)


 * You don't need to tell me that children with sickle cell get strokes, silent or otherwise.
 * Your ranting at Jmh649 has nothing to do with his administrator status; if he had protected an article or blocked a user this might be relevant.
 * Again, nobody is suggesting that content is deleted. What is being suggested is that the relevant content is moved to a place where it can be discussed in context. The term "silent stroke" attracts exactly 48 PubMed hits (link), so I think we should move away from this terminology in favour of discussing the pathophysiology of vascular dementia and sickle-cell disease. JFW &#124; T@lk  10:49, 11 September 2011 (UTC)
 * The image illustrating silent stroke is not of a silent stroke but a major stroke. The image is thus not appropriate. Doc James  (talk · contribs · email) 17:55, 12 September 2011 (UTC)
 * Um, that's not correct, the type of stroke depicted occuring in the Middle cerebral artery can occur in Silent stroke please read The Hisayama Study. thank you 7mike5000 (talk) 12:54, 1 October 2011 (UTC)
 * Yes silent strokes can occur in the MCA territory. But this is not a silent stroke. This is a full blown stroke. Ask any radiologist.-- Doc James (talk · contribs · email) 13:26, 1 October 2011 (UTC)

It seems to me that silent strokes are an important enough medical issue to need to be addressed somewhere; that the information on silent stroke given here is not redundant to that in the main stroke article (with the exception of some of the material on risk factors); and that there is too much good-quality information in the silent stroke artcle to be comfortably accommodated within the main stroke article. Cf on all points the discussion of TIA and lacunar stroke within the main article, but having them linked to standalone topic aricles. Mikalra (talk) 17:18, 28 September 2011 (UTC)
 * Peer reviewed articles on Silent stroke as the topic or that mention silent stroke predominately are in the 100's. That's because it is a major topic.

There are a few hundred more such as the Hisayama Study, Copenhagen Stroke Study and interesting studies such as Silent stroke warrants it's own article. Any physician worth his salt knows that. 7mike5000 (talk) 12:42, 1 October 2011 (UTC)
 * Silent stroke in the NINCDS Stroke Data Bank: "Previous brain infarctions seen on CT are common in the absence of history of stroke. Eleven percent of patients (135/1,203) without stroke history had ischemic lesions on their first CT, unrelated to the presenting stroke".
 * Framingham Study: "It is common to find computed tomography scan evidence of prior stroke without a history of such an event"
 * "The relations between the carotid lesions and the incidence, size, or localization of the brain lesions were investigated. RESULTS: The incidence of silent infarcts was 42% in all subjects and significantly increased with advancing age (P < .05). Most lesions were smaller than 1 cm in diameter and were usually localized in the subcortical white matter or the basal ganglia"
 * Incidence of silent cerebral infarction in patients with major depression: "Our findings suggest that half of presenile-onset major depression and the majority of senile-onset major depression might be organic depression related to silent cerebral infarction"

this topic should not be merged, the entire subject of stroke - from micron stroke to silent cerebral ischemia/infarction thru TIA and all the way up to CVA is so complicated that separation is needed for each topic as research, treatments, and concepts should be developed for each specific area. Ltk59 (talk) 15:05, 25 November 2011 (UTC)
 * Don't merge. The organisers of World Stroke Day felt the topic of silent stroke was worth focussing on in 2008, and even a cursory look at medical websites and literature shows significant coverage of this variant of stroke - I fail to see how Doc James missed this. Doc James hasn't given any good reason to merge or explained how the merge would be accomplished, and he's not explained how this is a "coatrack". If you don't like the content as it stands, edit the article. Fences  &amp;  Windows  23:45, 3 January 2012 (UTC)
 * Closed as non consensus. Doc James  (talk · contribs · email) 02:38, 7 January 2012 (UTC)

External link - What is the problem
I found this page meets the EL criteria, can someone (preferable the editor who reverted by contributions) WP:EL--Halqh حَلَقَة הלכהሐላቃህ (talk) 08:04, 16 January 2012 (UTC)
 * Have added DMOZ. Feel free to add the external links there. Cheers Doc James  (talk · contribs · email) 08:53, 16 January 2012 (UTC)
 * Thanks, but to avoid any issue i have started [] Because I think people just revert new editors to topics without even looking. EL criteria is met in my opinion. As a reader The current article I dont understand, I am not a Dr. It was not written for the layman. The external link helps me understand.--Halqh حَلَقَة הלכהሐላቃህ (talk) 09:54, 16 January 2012 (UTC)
 * Wikipedia needs improvement yes but that is not done by just adding links. If people want to good search they are free too. If people need simple content it can be found in simple English http://simple.wikipedia.org/wiki/Stroke_(medicine) I am working on a project to improve the content on Wikipedia as described here http://en.wikipedia.org/wiki/Wikipedia:MED/Translation_project and will get to stroke eventually. Doc James (talk · contribs · email) 10:03, 16 January 2012 (UTC)
 * Different people use wiki in different ways, but I think the simple stroke article should be somewhere at the top of this article. And every article should have good external links just as much as it should have good references. --Halqh حَلَقَة הלכהሐላቃህ (talk) 10:15, 16 January 2012 (UTC)
 * Wikipedia is based on consensus which one the English wiki can take some time to get. The key point is that we are a free encyclopedia... Doc James  (talk · contribs · email) 10:42, 16 January 2012 (UTC)

Reference 3
It seems to me that the sentence "It is the leading cause of adult disability in the United States and Europe and the second leading cause of death worldwide", which references [3], has nothing to do with the reference [3]. In [3], neither Europe, the US, nor "leading cause" are mentioned. 129.206.253.136 (talk) 17:46, 16 April 2012 (UTC)


 * You're correct. This is the reference:
 * I'm pretty certain that the statement can be supported by another of Valery Feigin's papers, but not this one. JFW &#124; T@lk  19:17, 16 April 2012 (UTC)
 * Reference the "second leading cause of death worlwide" assertion (which currently requires citation according to main article), the WHO state this is the case at http://www.who.int/mediacentre/factsheets/fs310/en/index.html which is based on their statistics from WHO member countries. It does not say anything about cause of disability in US and Europe. The reference [3] that this talk disucssion relates to appears to be no longer present on the main article and I have not located the revision it was removed so I cannot comment on the rest of the discussion. Loz hurst (talk) 13:53, 28 May 2012 (UTC)
 * Part of this is supported in the section on epidemiology Doc James  (talk · contribs · email) (if I write on your page reply on mine) 10:58, 3 September 2012 (UTC)

IST-3
This paper which came out in June 2012 found no significant difference in the number of those alive and independent at 6 month when treated with rtPA within 4.5 hours. The authors however misrepresent the numbers in their concluding words. Strange no? http://www.ncbi.nlm.nih.gov/pubmed/22632908 Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:12, 3 September 2012 (UTC)
 * This data is contained within the meta analysis in the lancet thus I have expanded upon our conclusions using it. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 11:55, 3 September 2012 (UTC)

Edit request on 11 November 2012
This is a request for an established user to add the following to the "Rehabilitation" section of the Stroke page: Modulating neuroinflammation is an emerging treatment option for chronic brain dysfunction due to stroke and traumatic brain injury. Etanercept, a biologic TNF inhibitor, previously demonstrated in animal models to reduce microglial activation and improve traumatic brain injury, has been documented to reduce motor impairment and spasticity in patients with Stroke, even years after brain injury.

63.130.249.171 (talk) 19:45, 11 November 2012 (UTC)

Please note- the article has been cited by a reliable secondary source - see Clark, Ian, New Hope for survivors of chronic stroke and traumatic brain injury, CNS Drugs, volume 26, issue 12, Dec. 2012, available online Nov. 7, 2012. http://www.ncbi.nlm.nih.gov/pubmed/23100197 ; Clark's independent commentary specially addresses the article, and cites to additional literature (see Clark reference 1) that discusses inflammation as a therapeutic target


 * Even if it works, it is not standard treatment by any means. We cannot tell readers that treatment is being used, while in fact it is not widely available for this indication. It might be suitable for the "Research" section if there are high-quality secondary sources that place particular emphasis on this treatment. JFW &#124; T@lk  00:13, 12 November 2012 (UTC)

This is a major advance and at least belongs in the research section, new information should not be suppressed, readers are not served by censorship. Readers deserve to be informed of its availability, even if it is limited, why would you not want them to know? — Preceding unsigned comment added by 63.130.249.171 (talk) 11:49, 12 November 2012 (UTC)


 * I agree with JFW. There is a similar discussion about "Traumatic brain injury" here. Axl  ¤  [Talk]  12:00, 13 November 2012 (UTC)


 * In response to, I am less than delighted with your characterisation of "censorship". This has arisen time and time again in different articles on health subjects: how much space do we devote to treatments still under investigations?
 * I could reverse your argument, and state that it is unethical to tell the general public about an investigational treatment that has not yet been fully tested and adopted, because people might seek it and come to harm (as with dichloroacetate for cancer) or end up being disappointed when they bring it up in their physician's office. JFW &#124; T@lk  18:52, 13 November 2012 (UTC)
 * I am closing this edit request as this ongoing discussion indicates there is no consensus for the requested edit. Please feel free to continue this discussion. &mdash; KuyaBriBri Talk 16:04, 15 November 2012 (UTC)

2013 statistics update
May be useful: http://circ.ahajournals.org/content/127/1/e6.full Ocaasit &#124; c 17:24, 2 February 2013 (UTC)

EM clinics
Has a whole issue on stroke  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 16:35, 10 February 2013 (UTC)

EM Rehabilitation Section
I think most of this information is correct, however, I would like to see part of the information corrected. I happen to know that the virtual reality therapy mentioned is part of what is called Therapeutic Recreation. And as a member of ATRA (American Therapeutic Recreation Association)who is becoming a CTRS (Certified Therapeutic Recreation Specialist), I would like Recreation Therapists put on the list of the treatment team who helps people regain their range of motion, strength, and mobility back after having a stroke. I would also like to see that the virtual reality therapy mentioned to be known for what it is--Recreation Therapy.

Home Rehabilitation for Stroke Using Virtual Reality Gaming Technology (Wii) May Be a Useful Rehabilitation Strategy. (2010). MD Conference Express, 22.

Yang, H., & Poff, R. (2001). VIRTUAL REALITY THERAPY: Expanding the Boundaries of THERAPEUTIC RECREATION. Parks & Recreation, 36(5), 52. — Preceding unsigned comment added by 128.187.97.23 (talk) 23:21, 22 April 2013 (UTC)

Mortality data
Hello, I would suggest the following change. Under 'Epidemiology' the article quotes a study from 2009 'Stroke was the second most common cause of death worldwide in 2004, resulting in 5.7 million deaths (~10% of the total).' It turns out that this information is not correct anymore and new studies argue that, while stroke is still a leading cause of disability and death in the world, it is actually declining (in the US and worldwide). It is not the second most commen cause of death anymore. For example, there is a new study from 2011 which says that death by stroke declined in the US: http://www.ncbi.nlm.nih.gov/pubmed/21778445 Thus, I suggest that we replace the sentence with 'Stroke is a leading cause of death and disability in the world, but declined recently from the third leading to the fourth leading cause of death in the US.' — Preceding unsigned comment added by ThomasLumid‎ (talk • contribs)
 * We place global stats first. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 23:34, 26 May 2013 (UTC)

Primary source
This content is based on an insufficient source. Have removed once. Wondering what others thoughts are? Is of undue weight. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:46, 27 May 2013 (UTC)

WP:MEDRS
Transferred from Paul venter's talk page:

Please use high quality secondary sources for medical content such as review articles or major textbooks. Thanks. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:33, 27 May 2013 (UTC)
 * Whether sources are of high quality or not, is fairly subjective. If you can find more reliable sources then feel free to add those. Please carry on with this discussion on the article's talk page and not here. Paul venter (talk) 16:44, 27 May 2013 (UTC)
 * It is not subjective at all. Have asked for further input from WT:MED. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 16:45, 27 May 2013 (UTC)


 * Firstly, this treatment is only used experimentally, so we cannot give the impression that it is used widely. If we are to discuss it at all, it will be in the "research directions" section. Secondly, this is an encyclopedia and not a journal club; we can therefore not discuss study methodology and the role of chance in the way that Paul wanted to. Thirdly, with a common condition such as stroke I would really not want to base any content at all on sources that are not secondary sources (reviews, professional guidelines or textbook chapters); within Wikipedia there is strong consensus that we should avoid primary sources as much as conceivably possible. This article is not an exception. JFW &#124; T@lk  17:25, 27 May 2013 (UTC)


 * The article is quite clear about the experimental nature of the trial and mentions only 9 subjects - I cannot see how anyone can gather from those words that it is a well-established procedure used widely. If the wording offends then improve the section, but I think it reflects a blinkered attitude to ignore primary research because it has not been published sufficiently. Paul venter (talk) 08:24, 28 May 2013 (UTC) "All Wikipedia articles should be based on reliable, published secondary sources. Reliable primary sources may occasionally be used with care as an adjunct to the secondary literature, but there remains potential for misuse. For that reason, edits that rely on primary sources should only describe the conclusions of the source, and should describe these findings clearly so the edit can be checked by editors with no specialist knowledge. In particular, this description should follow closely to the interpretation of the data given by the authors or by other reliable secondary sources. Primary sources should not be cited in support of a conclusion that is not clearly made by the authors or by reliable secondary sources, as defined above (see: Wikipedia:No original research). When citing primary sources, particular care must be taken to adhere to Wikipedia's undue weight policy. Secondary sources should be used to determine due weight."
 * A "acute ischemic stroke treatment" search in pubmed gives 10k articles. How are you going to decide which ones merit inclusion in the article? Are you going to name them all????. To use the one you included is to give undue weight to a non-notable study. Notability on what to include in articles is indeed given by secondary sources. The opposite would take this and other articles to be laundry lists including the content of any abstracts any editor decides is interesting.--Garrondo (talk) 09:04, 28 May 2013 (UTC)
 * No, I didn't attempt to name them all, but happened to choose one, which you in your wisdom have decided is not notable. This article is obviously owned by a self-appointed clique who will not tolerate any contribution not first mooted by them. Enjoy your oligarchy!! Paul venter (talk) 13:40, 28 May 2013 (UTC)
 * Not at all: I have no wisdom whatsoever, that is the precise reason why I follow secondary sources: because I prefer to use as sources those created by people who are trying to give a broader perspective of a whole subject as experts in their field (which certainly I am not). Moreover, I have given examples below of suitable references that would greatly enhance the article and you are most welcomed to use or search for similar ones. --Garrondo (talk) 13:54, 28 May 2013 (UTC)


 * Fully agree with the above: there are surely plenty of secondary sources on the directions of ongoing research on stroke (As examples from a fast search see, , ). No need to cherry-pick a primary article from the thousands that each year are published. Moreover, while I fully agree that wikipedia editors are not the ones to decide on the quality of primary references for our articles, in this case the cherry-picked article is also IMO underpowered, higly preliminary and without the rigor a real clinical trial...so even if WP was the place for primary articles, this should not be one of them. --Garrondo (talk) 20:00, 27 May 2013 (UTC)

Epidemiology statistics update
There are new statistics for death by stroke for 2008 and I suggest to update the old numbers. I would also suggest to rephrase the sentence slightly. http://who.int/mediacentre/factsheets/fs310/en/ I will also add the US statistics later. Thomas
 * Yes looks good. Thanks Doc James  (talk · contribs · email) (if I write on your page reply on mine) 17:55, 27 May 2013 (UTC)

Edit request on 26 June 2013
No one refers to a stroke as a "cerebralvascular accident" (CVA) anymore. This is an outdated term that no longer exists in today's medical world. Please remove CVA from the first sentence or change the first sentence from "A stroke, or cerebrovascular accident (CVA), is the rapid loss of brain function due to disturbance in the blood supply to the brain," to "A stroke, formerly referred to as a cerebrovascular accident (CVA), is the rapid loss of brain function due to disturbance in the blood supply to the brain." This one of the few errors on this B-class article. Thank you.

LongShaunSilvr (talk) 19:05, 26 June 2013 (UTC)
 * Looks like dentists still do and so does the ICD9 .  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 19:21, 26 June 2013 (UTC)
 * Quoted sentence gives 600 results in the last 5 years in pubmed, so I believe that even if it is not use as much as previously, it is still a common current term.--Garrondo (talk) 20:07, 26 June 2013 (UTC)


 * In clinical practice, oldfashioned terms die slowly. In other words, an official body can change the nomenclature and clinicians will continue to use outdated terminology for several decades. I still encounter "CVA" on a daily basis in clinical practice, although I personally avoid the term (though I might use "cerebrovascular event" in the broad sense for stroke/TIA/ICH if the exact diagnosis is doubtful). I think the older term deserves a mention in the intro, as long as we tell the reader that by using it you reveal your age. JFW &#124; T@lk  21:55, 26 June 2013 (UTC)

apoplexy
Yes it is a very old term for stroke but not used any more. Thus should go in the history section, not the first sentence. It is already there in fact. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:17, 30 August 2013 (UTC)
 * Have moved most of the history of the naming of this condition to the history section. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 21:23, 30 August 2013 (UTC)

Proper refs needed
Moved this here until properly referenced

"The practical results of ischemia of brain tissue have been known to humans since prehistory, and has been called "stroke" in English for centuries. Before the advent of medical science, there could be little precision in the terminology, because little was known about pathogenesis (or about physiology at all, in fact). Thus, for example, a variety of syndromes (sets of symptoms) could be labeled "stroke", and there was no distinction of (because no understanding of) transient versus permanent ischemic action. Starting in the 1630s the term apoplexy was sometimes used as a synonym of "stroke", and it is still entered in dictionaries as such a synonym, although it is no longer used that way in present-day medicine (seeapoplexy for the meaning that it is now restricted to).

As science-informed medicine has advanced, there has been some retronymy as an effort is made to speak with more precise definitions. Starting in the 1940s, the term cerebrovascular accident (CVA) gained currency. But it was not always used in ways that maintained a distinction between transient ischemia with reversible effects and prolonged ischemia with irreversible effects."

Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:30, 30 August 2013 (UTC)

Additional website
I'd like to offer my website http://www.strokeeducation.co.uk/index.html as a source of further information. Its a comprehensive coverage of contemporary stroke care which I have made free and have no commercial or other interests. I am a stroke physician and specialist. Guidelines quoted are international and authoritative. Declan O'Kane — Preceding unsigned comment added by 90.197.197.177 (talk) 18:56, 6 November 2013 (UTC)
 * We are not a collection of links to other websites but are trying to build an encyclopedia here. You website is not listed as being under an open license but is copyright by you. Thus we are unable to use any of the images contained there. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 16:30, 22 February 2014 (UTC)

"The older term cerebrovascular accident"
Re. this edit: stroke in the medical sense dates from the 1590s. See its entry on EtymOnline.com. The term "cerebrovascular accident" was introduced in 1927. So, regardless of the fact that "cerebrovascular accident" is discouraged by some physicians (because, supposedly, an illness that has clear underlying causes cannot be called an "accident"), it certainly is not the older term. I have therefore removed the reference to it being older. - TaalVerbeteraar (talk) 16:44, 29 September 2013 (UTC)


 * You may be right, but your edit has removed the important point that the term "cerebrovascular accident" is outdated and has been deprecated. I have changed it. JFW &#124; T@lk  19:52, 29 September 2013 (UTC)


 * I see that Jfdwolff has edited this to refer to CVA as a "deprecated term", this seems like it's appropriate, and more direct than calling it "older". I'd say it's an improvement. --Keithonearth (talk) 20:09, 29 September 2013 (UTC)
 * We are a general encyclopdia. We need to use general language and deprecated is not. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 02:35, 30 September 2013 (UTC)


 * But the term "older" is not correct - I agree with TaalVerbeteraar on that. Any ideas on how to get this right? I give up. JFW &#124; T@lk  22:02, 30 September 2013 (UTC)

How about "sometimes refer to by the less accepted term" Doc James  (talk · contribs · email) (if I write on your page reply on mine) 03:31, 1 October 2013 (UTC)
 * I think this pretty much deals with the issue. It avoids contentious labels such as "deprecated" or "less accepted" and incorrect labels such as "older" and refers the reader to the relevant paragraph that explains the origin of the term and the reason for which it is now discouraged. - TaalVerbeteraar (talk) 12:05, 1 October 2013 (UTC)
 * We do not typically link like this. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 02:47, 2 October 2013 (UTC)
 * In article redirects are allowed. I undid your good faith edit. Lentower (talk) 03:28, 2 October 2013 (UTC)
 * Lets let others weigh in. I disagree that we should have this sort of link right in the lead. The point is really not that important to deserve this link. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 04:07, 2 October 2013 (UTC)

Doc James, this wouldn't be the first article to include a link to a "naming" section in the lead. See, for example, American Civil War. I do agree with you, though, in that in this case, I don't find the issue important enough to insist that it should be referenced to in the lead. However, I accept that I may be biased regarding this issue, as in the country in which I practise medicine (the Netherlands) this isn't an issue at all. Neurologists (and neurology textbooks, and official neurology associations) here invariably use the "CVA" term and the Dutch equivalent of "stroke" – beroerte – is exclusively a layman's term. I respect that this might be more of an issue in the English-speaking medical community. - TaalVerbeteraar (talk) 12:18, 2 October 2013 (UTC)
 * TaalVerbeteraar raises the point of whether the "CVA" term is still in use anywhere in the English speaking world. Can anyone tell us about usage outside the US? E.g. the usage in England? South Africa? India? Australia? New Zealand? Elsewhere? Seems quite possible that CVA is only older in part of the English speaking world. Until we have a better understanding of this, mention of it should stay in the lead. Has anyone check with the editor who first added it? WP:AGF suggests we trust this editor that it is current enough. Lentower (talk) 16:19, 2 October 2013 (UTC)
 * It is still sometimes referred to as a CVA. The discussion of how often can take place lower in the article. Adding further detail to the lead is IMO UNDUE weight. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 18:14, 2 October 2013 (UTC)


 * James is correct that the discussion of the nomenclatural evolution should be excluded from the lede and also even from the "Definition" section. And he is right that it should be covered lower in the article. (The "Definition" section should have a short linked cross-ref down to it.) The "History" section is an appropriate place. It is also true, however, that the development of this coverage has kind of been made more difficult than it needs to be, because accurate phrases have been deleted rather than moved down. There has been a feeling (whether intended or not) of "yeah that's true but you're not allowed to say it", which is always frustrating to would-be contributors whenever it arises on Wikipedia. The solution is to adequately explain the sequence of events in the right section. Some of it is already covered under "History", but cohesiveness is still lacking. The word "stroke" is ancient (predating medical science) but its exact definition has changed by being narrowed by medical science. The term "CVA" was coined and popularized but is now considered outdated by some English-speaking users, not only because of the "accident" connotations (currently mentioned) but also just as much because it did not address the important transient-vs-irreversible difference. In current preferred English-language terminology, "stroke" is restricted to the irreversible types and "transient ischemic attack" (TIA) covers the transient types. Quercus solaris (talk) 15:54, 3 October 2013 (UTC)


 * I'm not sure about your second argument. While linguistically there is no reason why the term "cerebrovascular accident" shouldn't also cover transient ischemia, to my knowledge it is used in practice only to describe hemorrhages and irreversible ischemia ("strokes"). However, if you can provide a reliable source that gives this as a reason for the discouragement of the term, then by all means include it in the article. - TaalVerbeteraar (talk) 13:31, 4 October 2013 (UTC)

I'm slightly late to this discussion, but I'd like to add that there is one more term I've encountered; cerebrovascular insult or CVI. This also seems to be deprecated terminology, but it might do well to mention it in the etymology/history section. I've found sources in the last few years that use this terminology, but mostly in English abstracts of non-English articles. I'll look up some etymology and add this if there are no objections. CFCF (talk · contribs · email) 15:57, 22 February 2014 (UTC) Ping! . Think you might have missed what I added, I only fixed the formatting of the comment below since I was here anyway. CFCF (talk · contribs · email) 16:54, 22 February 2014 (UTC)

Assessment comment
Substituted at 22:08, 3 May 2016 (UTC)