Epidemiology

Stroke is the second leading cause of long-term disability in high-income countries and the second leading cause of death worldwide (1). In Western communities, about 80% of strokes are caused by focal cerebral ischemia, secondary to arterial occlusion, 15% by intracerebral hemorrhage, and 5% by subarachnoid hemorrhage (2). The World Health Organization has estimated that there were, worldwide, 16 million first-ever strokes and 5.7 million stroke deaths in 2005. These numbers are expected to rise to 18 million and 6.5 million, respectively, in 2015 (3).

The median annual incidence of first stroke in Western countries has been estimated to be about 200 per 100,000 for all age groups combined (2, 4). This incidence is highly age-dependent. The median stroke incidence in persons between 15 and 49 years of age is 10 per 100,000 per year, whereas this is 2,000 per 100,000 for persons aged 85 years or older (5). Most studies have shown a somewhat higher stroke incidence among men. Hispan-ics and African Americans have a higher risk of stroke than Caucasians; in African Americans, stroke incidence is about twice as high as in Caucasians (5). Stroke prevalence increases from about 50-100 per 100,000 in people between 25 and 34 years of age to about 10,000 per 100,000 in people of 85 years of age or older (6).

Thirty-day case fatality rates for ischemic stroke in Western communities generally range between 10 and 17% (2). Stroke outcome strongly depend-snot only on age and comorbidity, but also on the type and cause of the infarct. Early case fatality can be as low as 2.5% in patients with lacunar infarcts (7) and as high as 78% in patients with space-occupying hemispheric infarction (8).

Atherosclerosis, leading to thromboembolism or local occlusion, and car-dioembolism are the leading causes of brain ischemia, but unusual causes should be considered especially if patients are younger (Table 1) (9).

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