WORLD DAY PROCLAMATION (Cont.)

BUILD TRANSDISCIPLINARY TEAMS FOR WORKING GROUP O Busse Vice-President, German Stroke Society, Germany J Marler USA STROKE CARE AND REHABILITATION L Candelise Italy A R Massaro Brazilian Academy of , Brazil L R Caplan USA C Millikan USA 29th October ORGANIZED STROKE CARE IMPROVES Vladimir Hachinski (Chair) C Chen Singapore D Milne Vice President, American Stroke Association, OUTCOMES President, International Society for Behavioural and Cognitive Vascular Disorders, Vice-President, World Federation of Neurology R Cheung President, Hong Kong Neurological Society Vice President, Patient but remains the exception nearly everywhere. Chair, Stroke Affairs and Liaison Committee, World Federation of Neurology R Cote Canada J P Mohr USA WORLD STROKE DAY J Cuanang President, Philippine Stroke Society, Philippines K Nagata Research Institute for Brain and Blood Vessels, Therefore we need to: Johan Aarli President, World Federation of Neurology (WFN) A Davalos Spain Japan • Establish simple but comprehensive stroke units. Ruth Bonita New Zealand S M Davis Australia B Norrving Secretary International Stroke Society, Sweden Stroke units have long proven their worth, even Antonio Culebras President, World Stroke Federation (WSF) O H del Brutto Ecuador S Olson American Academy of Neurology, USA A day with a message for every day: in their most basic form. Praful Dalal Vice-President, Indian Stroke Association G J Del Zoppo USA J M Orgogozo France Geoffrey Donnan Chair, Oversight Committee ISS/WSF A Dishaw Ministry of Health of Ontario, Canada N V Ramani Singapore National Stroke Association • Encourage transdisciplinary teams to develop Vivian Fritz President & Chairperson of South African Stroke J D Easton USA E B Ringelstein Vice President, German Stroke Society, STROKE IS A TREATABLE AND expertise and translate evidence into practice. Foundation, South Africa C J Estol President, Argentine Cerebrovascular Germany • Build a health care system that responds to the Werner Hacke Chair European Stroke Initiative, Chair, European Association, Argentina J Robertson USA PREVENTABLE CATASTROPHE needs of each individual dealing with the impact Stroke Council, Germany A Etribi Egypt D Russell Chair, Scandinavian Stroke Society, Norway of stroke and rejoining society. Daniel Hanley National Stroke Association J M Ferro Portugal R L Sacco USA Markku Kaste Past Chair, European Stroke Initiative, Executive, C Fieschi President, Italian Stroke Forum, Italy A San Luis President, Asia and Oceania Association of ACTIVELY ENGAGE THE PUBLIC AROUND Board Member, European Stroke Council M Fisher USA Neurology, Philippines Ashraf Kurdi Jordan THE WORLD A J Furlan USA P Sandercock Co-ordinating Editor, Cochrane Stroke Group, Josè Larracoechea Spanish Neurological Society, Spain THE PUBLIC, ACTING AS INDIVIDUALS, O Fustinoni Stroke Society, Argentina UK World Stroke Day 2008 Mary Lewis Heart and Stroke Foundation of Ontario N Futrell USA D G Sherman USA VOTERS OR ADVOCATES, CAN BEST John W Norris Joint Chair, 5th World Stroke Congress L B Goldstein USA Y Shinohara President, Japan Stroke Society, Japan "Little , Big Trouble" INFLUENCE THEIR OWN FUTURE RISK AND Brian O’Grady Chief Executive, Stroke Foundation New Zealand M Goldstein Vice-President UCP, Research and Educational A Shuaib Canada CARE Inc. (retired) Foundation, USA V Skvortsova Vice-President, National Stroke Association of Sir Niphon Poungvarin President, Thai Neurological Society, Founding. P B Gorelick USA Russian Federation, Secretary, European Stroke but not enough is being done. President, Thai Stroke Society, Thailand M Grond Chair, German Stroke Society Council, Russia Therefore we need to: Jeanette Rewucki Canada J C Grotta USA J Suwanthemee President, Thai Stroke Society, Thailand Wendy Segrest Director of Operations, American Stroke • Increase awareness of the public, policymakers, E Gusev President, National Stroke Association of T Swift President, American Academy of Neurology, Association Russian Federation, Russia USA and health professionals about the causes and Sidney C Smith Jr. Chair, Heart and Stroke Forum, World Heart A Hakim CEO and Scientific Director, Canadian Stroke A Tehindrazaranivelo Madagascar and France symptoms of stroke. The symptoms of stroke are Federation Network, Canada P Trouillas France painless and at times transient ñ but sudden Phillip Teal Chair, Canadian Stroke Consortium G J Hankey Australia K N Vemmos Greece weakness or numbness in the face, arm or leg, James F Toole Past President, International Stroke Society M E Harriman Associate Executive Director, Heart and Stroke N G Wahlgren Sweden sudden inability to speak or understand speech, Takenori Yamaguchi President, Japan Stroke Association, Japan, Foundation of Canada M Walker USA loss of vision in one eye, or sudden loss of President of the International Stroke Society S Haussen President, Brazilian Academy of Neurology Y Wang China balance are as compelling an emergency Frank M Yatsu Treasurer, International Stroke Society W D Heiss Past President, European Federation of S Warach USA as crushing chest pain or sudden, severe unusual Neurological Societies C Warlow UK headache. M Hennerici Chair European Stroke Council, Germany L R Wechsler USA • Send a unified, consistent message throughout INTERNATIONAL ADVISORY D Huber Business Manager, Canadian Stroke Consortium, F Woimant President, French Stroke Society the world: Stroke is a preventable and treatable COMMITTEE Canada K S Wong Hong Kong catastrophe H H Hu Taiwan Stroke Society, Taiwan M C Wong Singapore D Inzitari Italy T Yanagihara Japanese Neurological Society G W Albers USA L J Kapelle President, Dutch Neurovascular Taskforce Group B W Yoon South Korea M Alberts USA R Kay Hong Kong Neurological Society, Hong Kong P Amarenco SOS ñ Attaque Cerebrale Association, France C S Kidwell USA C Anderson New Zealand Whereas; stroke is a global epidemic that threatens J S Kim South Korea J Baranski CEO, National Stroke Association, USA lives, health, and quality of life. A Korcyzn Israel P A Barber New Zealand J Kurtzke USA For more information, please contact: Whereas; much can be done to prevent and treat F Barinagarrementeria Mexico D LaBarthe USA stroke, and rehabilitate those who suffer one. J Biller USA H Lechner Medical Competence Centre, South East Europe, WSO Administrative Office N M Bornstein President, Mediterranean Stroke Society, Israel Austria C/o Kenes International Whereas; professional and public awareness is the M G Bousser President, French Neurology Society, RESEARCH GROUP K Lees Glasgow, UK 1-3 rue de Chantepoulet, P.O. Box 1726 first step to action. Founding President ñ French Stroke Society World Stroke

S R Levine USA CH-1211 Geneva 1, Switzerland P S

M Brainin Chairman, 6th World Stroke Congress ñ , Organization A

R R C Lopes President, Portuguese Stroke Society Tel: +41 22 906 9166 Incorporating E Austria; Treasurer World Stroke Federation K D the International Stroke Society I Lu Chuan-Zhen China and World Stroke Federation N R Fax: +41 22 732 2850 SO SO J P Broderick USA N DI We hereby proclaim an annual P D Lyden USA ISM AND RELATED S Brown CEO, Heart & Stroke Foundation of Canada, Email: [email protected] WORLD STROKE DAY E Magnis Vice-President, Strategic Alliances and Health IT, Canada American Heart Association / American Stroke A Buchan United Kingdom www.world-stroke.org Association, USA WORLD STROKE DAY PROCLAMATION WORLD STROKE DAY 2008 “Little Strokes, Big Trouble” Cape Town, the 26th of October, 2006 World Stroke Day 2008 STROKE: A PREVENTABLE AND TREATABLE CATASTROPHE

“Little Strokes, Big Trouble” THE GROWING EPIDEMIC Therefore we need to: Editorial published in Stroke - September 2008 STROKE IS PREVENTABLE • Encourage healthy environments to support healthy habits and lifestyles. but rising globally • Use effective drugs for both primary and Vladimir Hachinski, MD, DSc, Editor-in-Chief • Aging, unhealthy diets, tobacco use, and physical secondary prevention. Regretfully these drugs inactivity, fuel a growing epidemic of high are neither accessible nor affordable in many World Stroke Day is a day with a message for every day: “Stroke is a treatable and preventable catastrophe.” World Stroke Day, by focusing on “Little strokes, big trouble”, emphasizes the likelihood that the earlier blood pressure, high cholesterol, obesity, developing countries, nor used optimally in This year and every subsequent year it will be on October 29th. The theme for this year is “Little strokes, we intervene, the more likely we are to be successful and we will be acting on an ancient injunction, “Act diabetes, stroke, heart disease and vascular developed ones. big trouble”. before disease has gained strength” (Publius Ovidius Naso, Roman poet, 43 BC-17 AD). cognitive impairment. • Discourage unproven, costly, or misdirected The opinions in this editorial are not necessarily those of the editors or of the American Heart Association. • Worldwide, stroke accounts for 5.7 million During the World Stroke Congress in Vancouver in 2004, a working group was organized to develop a practices, which drain resources from more cost deaths each year and ranks second to ischemic global agenda for stroke. This agenda was subsequently incorporated into a World Stroke Proclamation From the Stroke Editorial Office, UWO Research Park, , Ontario, Canada. effective approaches. launched in Cape Town on October 26, 2006 (supplemental video, available online at heart disease as a cause of death; it is also a Correspondence to Vladimir Hachinski, MD, DSc, Editor-in-Chief, Stroke Editorial Office, UWO Research http://stroke.ahajournals.org). leading cause of serious disability, sparing no • Educate health professionals at all levels through Park, 100 Collip Circle, Suite 116, London, ON N6G 4X8, Canada. E-mail [email protected] (Stroke. age, sex, ethnic origin, or country. a common vocabulary, a core curriculum, on- The 2007 World Stroke Day theme was “Stroke is a treatable and preventable catastrophe and hypertension 2008;39:2407-2408.) line materials, long distance mentoring, and • Four out of five strokes occur in low and middle is its most common and treatable factor”. This year the stroke global agenda will be highlighted at the opportunities for learning in clinical practice © 2008 American Heart Association, Inc. income countries who can least afford to forthcoming 6th World Congress of Stroke, Vienna, September 24 to 27, 2008. settings. Stroke is available at http://stroke.ahajournals.org deal with the consequences of stroke. Although each year all aspects of stroke are addressed, a particular theme is selected for emphasis. This DOI: 10.1161/STROKEAHA.108.531681 • If nothing is done, the predicted number of year it emphasizes one of the items of the World Stroke Day Agenda: “Recognize, treat and prevent vascular Editoria RECOGNIZE THE UNIQUENESS OF STROKE people who will die from stroke will increase cognitive impairment. Subclinical (silent) strokes occur fives times as often as clinical (obvious) strokes and References THE DIFFERENT TYPES OF STROKE, ISCHEMIC to 6.7 million each year by 2015. may affect thinking, mood and personality” (World Stroke Day Proclamation appendix). 1. Leary MC, Saver JF. Annual incidence of first silent stroke in the United States: a preliminary estimate. (BLOCKAGE OF ARTERIES), BLEEDING INTO • Six million deaths could be averted over the Cerebrovascular Diseases. 2003;16:280–285. (INTRACEREBRAL HEMORRHAGE) AND By now it has become evident that “silent” strokes are the most common type of strokes. Results from 3 next 10 years if what is already known is applied. longitudinal studies suggest that 770 000 clinical strokes, about 9,000,000 “silent” infarcts and approximately AROUND THE BRAIN (SUBARACHNOID 2. Das RR, Seshadri S, Beiser AS, Kelly-Hayes M, Au R, Himali JJ, Kase CS, Benjamin EJ, Polak JF, O’Donnell • Much can be done to prevent and treat stroke 2,000,000 “silent” hemorrhages occurred in the United States in 1998.1 A recent article from the Framingham HEMORRHAGE) CJ, Yoshita M, D’Agostino RB, DeCarli C, Wolf PA. Prevalance and correlates of silent cerebral infarcts in and rehabilitate those who suffer the devastating HAVE SPECIFIC COURSES REQUIRING SPECIAL Study suggests that 1 in 10 individuals, stroke free and living in the community, with a mean age of 62±9 the Framingham Offspring Study. Stroke. 2008;39: In press. Epub ahead of print June 26, 2008. DOI: 2 consequences of stroke. TREATMENT AND REHABILITATION. years have a “silent” stroke. 10.1161/STROKEAHA.108.516575. The word “silent” is a misnomer. When subjects with “silent” infarcts are examined they have subtle 3. Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. JOIN FORCES TO PREVENT STROKE Therefore, we need to: 3,4 neuropsychological and neurological deficits. It is preferable to talk about “subclinical strokes”. Subclinical 2007;6:611– 619. THE SAME FEW RISK FACTORS ACCOUNT FOR • Study their causes and understand their 2 strokes correlate with the Framingham Stroke Risk Profile, but other factors may contribute to vascular THE LEADING HEALTH PROBLEMS OF THE mechanisms cognitive impairment. 4. Yaksuhiji Y, Nishiyama M, Yakushiji S, Hirotsu T, Uchino A, Nakajima J, Eriguch M, Nanri Y, Hara M, Horikawa E, Kuroda Y. Brain microbleeds and global cognitive function in adults without neurological WORLD • Organize skilled teams of physicians, If ignored, little strokes could spell big trouble. One subclinical stroke is associated with increased chance neurosurgeons, neurointerventionalists, and disorder. Stroke. 2008; 39: in press. but research about the common threat occurs in of having others and of experiencing a clinical stroke and/or .3 The combination of subclinical rehabilitation specialists to deal with these special isolation from other major chronic diseases. strokes and subclinical Alzheimer lesions may be a background for the association of stroke and dementia 5. Shehadri S, Beiser A, Kelly-Hayes M, Kase CS, Au R, Kannel WB, Wolf PA. The lifetime risk of stroke: types of stroke. given that the lifetime risk of developing either or both is one in three.5 estimates from the Framingham Study. Stroke. 2006;37:345–350. The common risk factors, tobacco use, physical From a practical viewpoint it becomes important to recognize that some of the symptoms that elderly 6. Pantoni L. : from an ancient term to an actual marker of poor prognosis. Stroke. inactivity, and unhealthy diet, contribute to stroke, RECOGNIZE, TREAT AND PREVENT individuals manifest, such as changes in judgment, in intellectual ability, personality change, particularly 2008;39:1401–1403. heart disease, diabetes, chronic lung disease, VASCULAR COGNITIVE IMPAIRMENT cancer, and pose a risk for Alzheimerís disease. depression, may be associated with subclinical strokes and changes in the brain.3,6 7. Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, PowersWJ, DeCarli C, SUBCLINICAL (”SILENT”) STROKES OCCUR FIVE TIMES AS OFTEN AS CLINICAL (OBVIOUS) A 5-minute screening instrument for vascular cognitive impairment and Alzheimer disease is recommended, Merino JG, Kalaraia RN, Vinters HV, Holtzman DM, Rosenberg GA, Dichgans M, Marler JR, Leblanc GG. Therefore we need to: STROKES, AND MAY AFFECT THINKING, which can be followed-up by a 30- and 60-minute battery if required.7 If the patient shows executive National Institute of Neurological Disorders and Stroke–Canadian Stroke Network Vascular Impairment • Co-ordinate the efforts of all disease-oriented dysfunction, it may justify brain-imaging and identification of possible subclinical strokes which then should Harmonization Standards. Stroke. 2006;37: 2220–2241. organizations working to prevent the rise of MOOD AND PERSONALITY. be treated and prevented based on the cause, ie, cardiac, cervical and cerebral and associated risk factors. 8. Whitehead SN, Hachinski VC, Cechetto DF. Interaction between a rat model of cerebral ischemia and these underlying risk factors. Therefore, we need to: beta-amyloid toxicity: inflammatory responses. Stroke. 2005;36:107–112. We should treat risk factors with renewed vigor and at that same time commit ourselves to discover whatever ENSURE WHAT WE KNOW BECOMES WHAT • Recognize that vascular cognitive impairment differences that may exist between clinical and subclinical strokes. It may not be simply a question of infarct 9. Hachinski V. Stroke and vascular cognitive impairment: a transdisciplinary, translational and transactional IS DONE (VCI) occurs commonly and at times hastens size, but of mechanisms and actions on different brain substrates, eg, the presence of amyloid, which approach. Stroke. 2007;38:1396–1403. Alzheimerís disease (AD) experimentally can magnify the size and inflammatory response of cerebral infarction.8 PREVENTION IS THE MOST READILY APPLICABLE AND AFFORDABLE PART OF OUR • Manage the common risk factors for stroke, VCI We need to implement what we know and learn as we do it, so that we can continue to improve the KEY WORDS: hypertension•vascular cognitive impairment KNOWLEDGE and AD (tobacco use, high blood pressure, high treatment and prevention of all types stroke.9 Stroke - September 2008 (pages 2407-2408) cholesterol, physical inactivity, obesity and but prevention is neglected. diabetes).