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April 13, 1994

Clinical Assessment of Stroke

Author Affiliations

From the Center for Health Policy Research and Education and the Divisions of Neurology (Dr Goldstein) and General Internal Medicine (Dr Matchar), Department of Medicine, Duke University Medical Center, and Department of Veterans Affairs Medical Center (Drs Goldstein and Matchar), Durham, NC.

JAMA. 1994;271(14):1114-1120. doi:10.1001/jama.1994.03510380070041

STROKE is the most common serious neurological disorder seen in a general hospital.1 Each year, approximately 500 000 Americans have strokes. About 150 000 of these individuals die, making stroke the third leading cause of death and the major cause of disability among adults.2 Of long-term stroke survivors, approximately 15% require institutional care, 30% are dependent in activities of daily living, and 60% have decreased socialization outside the home.3 The estimated costs of stroke-related care and lost productivity was $18 billion for 1993.2 Thus, the costs of stroke are enormous in human and economic terms.

The clinical evaluation of stroke patients often does not receive the attention it deserves. The "therapeutic nihilism" of the past4 is disappearing as effective treatments are established by prospective clinical trials. For example, endarterectomy has been shown to be useful in the prevention of major stroke in selected patients with

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