Preface

Although Gregor Nymmann and Johann Jakob Wepfer wrote books on apoplexy as early as the seventeenth century, it was James F. Toole's first edition of Cerebrovascular Disorders in 1967 that defined stroke as a field for study. It summarized what was then known about the anatomy, pathophysiology, diagnosis, and treatment of stroke in a fashion that was so clear, logical, and positive that it sparked in many of us a lifetime interest in the study of cerebrovascular disease. Despite centuries of observation, much of what we now deem useful knowledge about stroke has been discovered in the four decades since the 1967 appearance of Cerebrovascular Disorders. Stroke was then mostly a diagnosis based on bedside examination, knowledge of brain and vascular anatomy, clinical experience, and intuition. Therapeutic nihilism was the order of the day. Cerebral angiography could confirm certain diagnoses, and echoencephalography was used to detect displacement of the midline by a subdural hematoma or large intracerebral hemorrhage. Confirmation of a clinical diagnosis was difficult and awaited autopsy in the days before the now-ubiquitous imaging studies. The ensuing years have seen the development of multiple neuroimaging methods, new surgical and endovascular techniques, and new and more effective forms of therapy. But perhaps the most important long-term development in stroke care during the last few years has been the results of that increasingly augment clinical decisions.