Cerebrovascular disease.

On December 19, 1952, Dr C. Miller Fisher, in a lecture to the Montreal Medico-Chirurgical Society, “Concerning Strokes,” noted “. . . I was under the impression that the subject of cerebrovascular disease had already been well cut and dried by the pioneers of Neuropathology. . . . It became apparent that this was far from true, for many aspects of the subject had not yet been investigated and many details lacked clarity. What is more, few laboratories seemed interested in the subject, although as a cause of disability, illness and death, vascular disease of the brain has few rivals.”1 The leading textbook, H. Houston Merritt’s A Textbook of Neurology2 offered little diagnostic guidance for stroke beyond noting that shift of a calcified pineal and bloody spinal fluid favored hemorrhage over infarction. The treatment proffered was largely palliative. During this 50-year period, stroke as a discipline has moved forward. Advances in the past 30 years have occurred at a remarkable pace, and progress in cerebrovascular disease would appear to rival that of any other aspect of cardiovascular disease. Diagnosis and treatment of stroke patients in 1950 was based on a detailed clinical examination that virtually neurologists alone could perform and interpret. However, the neurologists of the day had few facts with which to analyze cases and even less in the way of diagnostic tools or therapies. In the interim, improvements have occurred in our understanding of the pathophysiological mechanisms of stroke, the availability of powerful diagnostic imaging tools, and the recent development of effective therapeutic measures. Importantly, stroke has repeatedly been shown to be preventable through risk factor modification, medications, and surgery.