Stroke: working toward a prioritized world agenda


  • From the Department of Clinical Neurological Sciences (V.H.), London Health Sciences Center, University of Western Ontario, London, Ontario, Canada; Florey Neurosciences Institutes (G.A.D.), Carlton South Victoria, Australia; University of Illinois at Chicago (P.B.G.), Chicago, Ill; University of Heidelberg (W.H.), Heidelberg, Germany; University of California–Irvine (S.C.C.), Orange, Calif; Helsinki University Central Hospital (M.K.5*), University of Helsinki; Helsinki, Finland; University of Massachusetts Medical School (M.F.), Worcester, Mass; University Donau-Universität Krems (M.B.7*), Krems, Austria; University of Oxford (A.M.B.), Oxford, UK; Massachusetts General Hospital (E.H.L., K.L.F., L.H.S.), Charlestown, Mass; Novo Nordisk (B.E.S.), Princeton, NJ; Royal Perth Hospital (G.J.H.), Perth, Australia; Karolinska Institute (M.K.2), Stockholm, Sweden; Washington University School of Medicine (J.M., M.P.G.), St. Louis, MO; John Radcliffe Hospital (P.M.R.), Oxford, UK; President-elect, AHA, University of Miami (R.L.S.), Miami, Fla; University of North Carolina (S.C.S.), Center for Cardiovascular Science and Medicine, Chapel Hill, NC, and President-elect, World Heart Federation, Geneva, Switzerland; InTouch Health (Y.W.), Goleta, Calif; Groote Schuur Hospital and University of Cape Town (UCT; A.B.), Cape Town, South Africa; Newcastle University (G.A.F.), Newcastle Upon Tyne, UK; Weill Cornell Medical College (C.I.), New York, NY; Hospital De Clinicas (S.C.O.M.), Porto Alegre, Brazil; University of California at Los Angeles Stroke Center (J.S.), Los Angeles, Calif; Russian State Research Stroke Institute (V.S.), Moscow, Russian Federation; Toronto Rehabilitation Institute (M.B.4), Toronto, Ontario, Canada; Neuroscience Research Unit (M.M.B.), Pfizer Inc, Groton, Conn; Duke University (P.D.), Durham, NC; GlaxoSmithKline (L.E.), Durham, NC; Biotrofix, Inc (S.F.), Waltham, Mass; University of Texas at Austin (T.A.J.), Austin, Texas; Kings College London (L.K.), London, UK; University of Florida (J.K.), Gainesville, Fla; National Center for Medical Rehabilitation/National Institute of Child Health and Human Development/National Institutes of Health (R.N.), Rockville, Md; St Joseph's Healthcare London (R.T.), London, Ontario, Canada; University of Freiburg (C.W.), Freiburg, Germany; Pomona Valley Hospital Medical Center (B.D.), Pomona, Calif; Max Planck Institute for Neurological Research (W.-D.H.), Koln, Germany; Terveystalo Medical Center (O.S.), Helsinki, Finland; Tachikawa Hospital (Y.S.), Tokyo, Japan; Southern Illinois Healthcare (B.T.), Carbondale, Ill; Karolinska Institute (N.W.), Stockholm, Sweden; Chinese University of Hong Kong (L.K.W.), Sha Tin, Hong Kong, China; The Canadian Stroke Network (A.H.), the University of Ottawa and the Ottawa Hospital Research Institute; Ottawa, Ontario, Canada; Lund University Hospital (B.N.), Lund, Sweden; American Heart Association (S.P.), Dallas, Texas; Tel Aviv Sourasky Medical Center (N.M.B.), Tel Aviv University, Tel Aviv, Israel; Director of Neurology (S.M.D.), Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia; Duke University and Durham VA Medical Center (L.B.G.), Durham, NC; University Lille Nord de France (D.L.), Lille, France; and the University of Helsinki (J.T.), Helsinki, Finland.

  • The numerical suffix with the names indicates the various groups. The coordinator of each group is indicated by an asterisk. The work of the coordinators is deemed to have been equal. The other authors are listed according to the sequence of their groups and alphabetically, and their work is also deemed to be equal to each other's.

  • Working Groups: (1) Basic Science, Drug Development, and Technology; (2) Stroke Prevention: Broadening the Approach and Intensifying the Efforts; (3) Acute Stroke Management: Applying and Expanding What We Know; (4) Brain Recovery and Rehabilitation: Harnessing the Regenerative Powers of the Brain and the Individual; (5) Into the 21st Century: The Web, Technology, and Communications: New Tools for Progress; (6) Fostering Cooperation Among Stakeholders to Enhance Stroke Care; and (7). Educating and Energizing Professionals, Patients, the Public, and Policymakers.

  • This article has been co-published in: Stroke. June 2010; Vol 41, Issue 6, Cerebrovascular Diseases. July 2010; Vol 30, Issue 2 and International Journal of Stroke. August 2010; Vol 5, Issue 4.

Vladimir Hachinski, MD, FRCPC, DSc, University of Western Ontario, University Hospital, 339 Windermere Road, London, Ontario, Canada N6A 5A5. E-mail


Background and Purpose The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke.

Methods Preliminary work was performed by seven working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium.

Results Recommendations of the Synergium are:

Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent ‘silo’ mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science.

Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques.

Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks.

Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery.

Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and registries.

Foster Cooperation Among Stakeholders (large stroke organizations, nongovernmental organizations, governments, patient organizations and industry) to enhance stroke care.

Educate and energize professionals, patients, the public and policy makers by using a ‘Brain Health’ concept that enables promotion of preventive measures.

Conclusions To accelerate progress in stroke, we must reach beyond the current status scientifically, conceptually, and pragmatically. Advances can be made not only by doing, but ceasing to do. Significant savings in time, money, and effort could result from discontinuing practices driven by unsubstantiated opinion, unproven approaches, and financial gain. Systematic integration of knowledge into programs coupled with careful evaluation can speed the pace of progress.