Top Things to Know: An Updated Definition of Stroke for the 21st Century
- The current World Health Organization definition most used in these modern times is outdated.
- This updated definition is based on newer understanding of basic science, neuropathology, and neuroimaging, and necessitates a new revised definition of stroke. Recent advances have greatly improved our understanding of cerebral ischemia, infarction, and hemorrhage.
- Occurrence of permanent injury is the basis of the new definition.
- This updated definition builds upon a revised tissue definition of transient ischemic attack (TIA) by the AHA/ASA in 2009, based on newer understanding of components related to stroke diagnosis.
- Tissue and clinical concepts applicable to practice, research, and public health assessments are included.
- Central nervous system (CNS) infarction is defined as pathology occurring in the brain or spinal cord, or retinal cell death due to ischemia.
- Ischemic death is based on clinical, neuroimaging, and neuropathological evidence of permanent injury.
- Both ischemic and hemorrhagic strokes are addressed.
- The new definition includes not only infarctions with overt clinical symptoms but also "silent infarction" -- asymptomatic infarctions with no known overt symptoms -- usually discovered by neuroimaging.
- With the identification of "silent infarction," potentially as a marker of other vascular diseases, appropriate prevention measures can be instituted depending on patient risk factors.
Citation
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, Elkind MSV, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS, Kase CS, Kleindorfer DO, Lee J-M, Moseley ME, Peterson ED, Turan TN, Valderrama AL, Vinters HV; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, and Council on Nutrition, Physical Activity and Metabolism. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013: published online before print May 7, 2013, 10.1161/STR.0b013e318296aeca. http://stroke.ahajournals.org/lookup/doi/10.1161/STR.0b013e318296aeca