Conquering Stroke

The past decade has witnessed significant advancements in the field of stroke medicine. Stroke, as the theme for this supplement, could not be more apt. The supplement encompasses a wide range of topics related to stroke, covering both basic science and clinical applications. Worsening quality of air, periodically exacerbated by seasonal changes, industrialization and loss of green cover in urban areas, places significant consequences to the health of its inhabitants. In the last two decades, air pollution has emerged as a significant risk factor for non-communicable diseases (NCDs), including stroke,[1] and a prospective study from India investigates this emerging risk. Stroke places a significant burden on caregivers and the community alike. Pre-hospital emergency care to minimize delay in diagnosis, and management of an acute stroke can decrease the morbidity caused by the event. The ideal treatment should begin even before the patient arrives at the hospital. The two articles about pre-hospital delay in stroke patients from China and India, and the evaluation of Wake-Up Strokes in the Emergency Department, cover this important area. These articles point to areas where pre-hospital care and referral can be strengthened. The articles on risk factors, aetiology, and outcomes of strokes in very old people, as well as Endovascular Management of Acute Ischemic Stroke in Octogenarians, are timely since the population in India above 80 years is expected to reach 32.0 million by 2051.[2] In the days past, disease-specific nomograms derived from statistical techniques like logistic regression have been used to predict the risk of events in diseases like cancer; increasingly, machine learning models are being trained on large databases for making those predictions. The articles on Machine Learning-Based Prediction of Length of Stay after Thrombectomy, Predictors of Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis, and Prediction Model for Estimating Hemorrhage Risk in Cerebral Cavernous Malformation Patients is of practical relevance. Cavernous malformations may pose a decision-making dilemma as many of these present with seizures or multiple minor bleeds but are located areas like the brainstem. Using SWI Clot Length in predicting Intracranial Atherosclerosis-related Large Vessel Occlusion in Acute Stroke patients is very relevant to our country, since intracranial atherosclerosis is more prevalent in Asians.[3] Finally, blood-based biomarkers have emerged as new tools for assisting in diagnosis and for prognosticating stroke patients.[4] This supplement features two articles on the topic of biomarker applications in the management of patients with stroke. These, together with other articles on infectious etiologies and infectious complications post-stroke, and challenging cases requiring thrombolysis, make this a well-balanced and an interesting supplement covering all aspects of stroke medicine.