Emergency physicians often encounter patients with acute, lateralizing, neurologic deficits. Although any disease process that interferes with cerebral perfusion can result in such a presentation, strokes are diagnosed in most patients presenting with these symptoms. In this article, we discuss nonhemorrhagic stroke syndromes: thrombotic strokes and embolic events. We briefly review the relevant neuroanatomy and the current understanding of the pathophysiology of stroke syndromes. We then present our approach to the clinical evaluation of suspected stroke patients and examine the current and emerging modalities for the treatment of these patients.

Each year in the United States, approximately 500,000 individuals suffer strokes; nearly a third of these are fatal and another third will have some residual disability. <sup>20 Heros R.C. Stroke: Early pathophysiology and treatment: Summary of the fifth annual decade of the brain symposium Stroke 1994 ;  25 : 1877-1881  [cross-ref]

Cliquez ici pour aller à la section Références</sup> In 1994, the direct costs of treating stroke patients were estimated to be $17 billion. <sup>29 National Stroke Association Cost of stroke Stroke Clinical Updates IV 1994 ; 9-12

Cliquez ici pour aller à la section Références</sup> In the past, therapeutic options were limited to monitoring and support of vital functions, and management of complications. However, much recent data suggest that effective interventions within hours of the onset of symptoms can significantly improve patients' outcomes. The current trends in treatment focus on what the National Stroke Association highlights as the therapeutic window of stroke in humans—the first 6 hours. <sup>26 McDowell F.H., Brott T.G., Goldstein M. , et al. Stroke the first six hours Stroke Clinical Updates IV: 1993 ;  12 : 1

Cliquez ici pour aller à la section Références</sup> In order to understand why we as emergency physicians must focus on rapid evaluation of the stroke patient, a clear understanding of the pathophysiology of stroke is essential. Before our discussion of pathophysiology, we thought a brief review of the vascular supply and anatomy of the brain would be useful.