An Updated Definition of Stroke for the 21st Century

TLDR

Stroke remains inconsistently defined across clinical practice, research, and public health, with the classic definition lacking consideration of modern scientific and technological advances. The Stroke Council convened a writing group to produce an expert consensus on an updated 21st‑century definition of stroke. The updated definition characterizes central nervous system infarction as irreversible cell death from ischemia, identified by neuropathology, imaging, or clinical evidence, and distinguishes symptomatic ischemic stroke from silent infarction while also encompassing intracerebral and subarachnoid hemorrhages. The updated definition incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.

Abstract

Despite the global impact and advances in understanding the pathophysiology of cerebrovascular diseases, the term "stroke" is not consistently defined in clinical practice, in clinical research, or in assessments of the public health. The classic definition is mainly clinical and does not account for advances in science and technology. The Stroke Council of the American Heart Association/American Stroke Association convened a writing group to develop an expert consensus document for an updated definition of stroke for the 21st century. Central nervous system infarction is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. Central nervous system infarction occurs over a clinical spectrum: Ischemic stroke specifically refers to central nervous system infarction accompanied by overt symptoms, while silent infarction by definition causes no known symptoms. Stroke also broadly includes intracerebral hemorrhage and subarachnoid hemorrhage. The updated definition of stroke incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.