Epidemiology of stroke in requiring intensive care.

Stroke is a leading cause of death and disability, particularly in the elderly population. The evolution of stroke prevention and treatment has reached a new stage whereby rapid evaluation and intervention can prevent stroke occurrence and its consequences. A stroke system much like a trauma system can be useful in getting patients to recognize signs and symptoms of stroke, mobilizing the emergency medical system (EMS), conducting diagnostic studies promptly, treating patients in a timely manner consistent with their disease process, stopping progression through monitoring and treatment, and beginning rehabilitation as early as feasible. The neurointensive care unit (neuro-ICU) is a key component of the system. It provides the monitoring and treatment for progressing stroke and its complications. Patients who might be suitable for neurointensive care are those with severe strokes, those receiving thrombolytic therapy, those receiving hypervolemia-hypertensive-hemodilution therapy, those at risk for intracranial and medical complications, and inhospital strokes following medical and surgical procedures. In order for patients to reach the neuro-ICU, education of patients, EMS providers, physicians, and hospital administrators with regard to the need for rapid response and intensive care is needed. The saga of myocardial infarction reaction is an example of the way a system of response can be developed. The concept of brain attack should alert the community and the healthcare providers of the urgency of stroke care and the need for a stroke system with neurointensive care as the therapeutic key.