**1. Introduction**

20 Rehabilitation Medicine

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effects of routine blood pressure lowering and intensive glucose control on macrovascular and microvascular outcomes in patients with type 2 diabetes: New Stroke is defined a sudden neurological impairment resulting from interruption of the blood supply and brain tissue damage. The most common symptom of a stroke is sudden weakness and/or numbness of the face, arms or legs, most often on one side of the body. Other symptoms include: confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; severe headache with no known causes; fainting or unconsciousness. Generally stroke means compromise of arterial blood supply (arterial stroke). Venous stroke is very rare in adult but not uncommon in children.

Strokes can be classified as either hemorrhagic or non-hemorrhagic (infarction). This classification helps to decide early therapeutic intervention. Hemorrhagic stroke is not indicated for t-PA (tissue plasminogen activator) protocol. Hemorrhagic stroke is most commonly related with hypertension or aneurysm in adults and with congenital vascular abnormality in children. Non-hemorrhagic stroke is more common than hemorrhagic stroke (8:2) in the United States and European countries1,2, however a more recent study shows 6:4 ratio3. This ratio varies in different races and cultures4.

The diagnostic procedures of stroke are identical in both adult and children. A meticulous history and neurological examination are the mainstays of diagnosis. Head CT (computerized tomography) is useful to differentiate hemorrhagic and non-hemorrhagic stroke in very acute phase. A brain MRI (magnetic resonance image) is requested if head CT is not diagnostic. Intracranial as well as extracranial vessels can be evaluated by a MRA (magnetic resonance arteriography). MRV (magnetic resonance venography) is indicated for venous stroke diagnosis.

In very acute phase of stroke (within 3 hours), a thrombolytic agent (t-PA) is recommended as a standard treatment for non-hemorrhagic strokes in adult. It decreases mortality and improves functional outcome, in spite of hemorrhagic complications5.
