THROMBOLYTIC THERAPY IN NEUROINTENSIVE CARE

Stroke is the third leading cause of death and the major cause of disability in the United States, affecting people of all ages.I7 More than 500,000 Americans are afflicted with strokes annually.35 The 30-day and 5-year mortality rates for stroke occurring in the carotid artery distribution are 17% and 40%, respectively. Of long-term stroke survivors, 15% require institutional care, 30% are dependent in activities of daily living, and 60% have decreased socialization outside the home.@ These outcomes create additional costs in human and economic terms. The American Heart Association (AHA) estimates that stroke costs the United States $15 to 20 billion ann~al ly .~ Stroke is newly referred to as "brain attack." This new terminology is purposely used to resemble the term "heart attack" and to underscore the fact that stroke is a medical emergency and not a cerebrovascular "accident." Data indicate that nearly as many Americans die or are disabled from strokes as from myocardial infarctions. However, according to a recent public survey by the AHA, 42% of respondents could not name one stroke risk factor, and 66% could not name a single stroke warning sign4 Stroke is a clinical syndrome characterized by a sudden onset of neurologic dysfunction of vascular etiology. There are two main types of strokes: hemorrhagic and ischemic. Hemorrhagic stroke accounts for 15% of stroke occurrences and is due to bleeding into brain tissue (parenchymatous or intracerebral hemorrhage) or bleeding into the sub-