Nihilism and stroke therapy.

In spite of recent advances in supportive management and prevention of stroke, it is not uncommon to hear nonneurologists as well as neurologists express the opinion that "nothing can be done for a patient with a stroke." These individuals are expressing an attitude of therapeutic nihilism. The word nihilism is derived from the Latin nihil, meaning "nothing." A therapeutic nihilist is one who shows skepticism regarding the therapeutic value of drugs. Since ancient times, therapeutic nihilism has been accepted in relation to diseases of the nervous system, particularly stroke. To trace the roots of nihilistic attitudes toward stroke, one must begin by analyzing the definition of apoplexy or stroke. Apoplexy means "struck with violence" in Greek and "being thunderstruck" in Latin. Stroke was not seen as an affliction from within the body, but the result of a force from outside the body, perhaps even celestial. This view is reflected best by the definition of stroke in the 1599 Oxford English Dictionary as a "stroke of God's hands." The logical deduction was that if the disease were caused by divine intervention, no human intervention such as drug therapy could possibly alter the outcome. Often, stroke has been referred to as a "cerebrovasoilar accident," a term that supports the concept of stroke as a random, unpreventable catastrophe. The term "cerebrovascular accident" should be banished from our vocabulary. Historical writings about stroke provide some insight into the evaluation of therapeutic nihilism. Hippocrates wrote that "to get over a strong attack of apoplexy is impossible, over a weak one, not easy." An indication of early thoughts about the prognosis of stroke is contained in the writings of Aretaeus of Cappadocia during the second century AD. He wrote that "should indeed the apoplexy be severe, they cannot survive the greatness of the illness combined with the misery of advanced life." Paul of Aegina expressed that, "in some patients, the power of speech was lost and if it did not return in 14 days, the physician should do something about it." In 1892, Osier stated that in cases of hemiplegja "the friends