Newsletter Januar 2016


Letter from the President

Dear friends

ESO activities in 2016 are off to a flying start.  I am impressed with the commitment and enthusiasm of our colleagues.  Across the festive period, millions of neurones were firing in bursts of productivity, leading to submission of abstracts for the ESO 2016 Conference in numbers already comparable to those of 2015. As I write, ESO Fellows are scoring the anonymised abstracts for programming purposes and by early February the eagerly anticipated acceptance letters or desperately feared apologies for lack of space will be mailed out to ever-hopeful authors.  Registrations are mounting, sponsors have signed on the dotted line, catering has been ordered, flights and accommodation are filling up …  but there are 4 months to go.  Late-breaking trials abstracts can still be submitted till 2 March 2016;  and Barcelona is a big city with excellent facilities:  we will squeeze you in somewhere.

Bo Norrving and Didier Leys are putting their final touches to the first issue of the new European Stroke Journal.  Several of us have already started to format manuscripts for ESJ, or have even tested the submission website. 

Philippe Lyrer’s stroke unit certification committee will announce their new process and web-based system during ESOC 2016. Thorsten Steiner and George Ntaios’ very active guidelines committee are preparing the ESO Guidelines App for launch shortly.  Meanwhile, the teaching and political activities of ESO are proceeding firmly along well established lines.

All of this effort is undertaken by committed professionals underpinned by a small administrative team at Congrex, our secretariat, and within our PCO, Kenes. We seem to be nominating an ever-expanding number of representatives to committee positions with our partner organisations, inviting colleagues to contribute lectures at joint symposia or looking for wise men and women to lead our new projects. Watch the ESO website, keep your details and interests updated, and please – continue to give us the generous and invaluable support, intellectual and temporal, that has built ESO into the influential group it has become. I wish to thank my fellow executive officers who are tireless in their efforts and fellow committee members and chairmen – all committees – because they are truly the powerhouse that drives us forward.

I am conscious that I have drafted several newsletters over recent months.  This may reflect the activity of the society but it neither indicates the true balance of credit nor the breadth of opinion in our organisation. Thus, we intend to share responsibility for newsletters among senior office bearers over the coming months, taking turns in maintaining contact with each of you.

Finally, I would like to extend my wish for a happy, healthy and successful year ahead to all of our colleagues and their families.

Kennedy Lees


Recent ESO activities

3rd European Stroke Science Workshop

November 19th to 21st 2015; Garmisch-Partenkirchen, Germany
More than 120 stroke scientists gathered at the Eibsee near Garmisch-Partenkirchen to discuss the latest results and hot topics in clinical, translational, and basic stroke research. Since its inception in 2011, the European Stroke Science Workshop (ESSW) has become a ‘must go’ and true highlight for researchers in the field.

This year’s program started with an evening lecture by Peter Rothwell (Oxford, UK) who asked “How much can we improve secondary prevention of stroke by better use of existing treatments?” The following days were packed with sessions on a wide range of topics. Nancy Rothwell (Manchester, UK) opened the topical focus on stroke immunology by reviewing current treatment approaches and trials. The session on acute stroke started with a lecture by Diederick Dippel (Rotterdam, The Netherlands) who summarized published and unpublished results from recent trials on endovascular therapy and together with the following speakers also addressed practical issues including criteria for patient selection, recanalization techniques, devices, and type of anesthesia.

As in previous years topics covered the entire range from basic science to clinical trials with everybody in one room and long time for discussions. Martin Lauritzen (Kopenhagen, Denmark) presented new data showing that pericytes regulate capillary blood flow, which got the audience into a stimulating discussion about the distinguishing properties of pericytes and vascular smooth muscle cells. Advances in imaging technologies were a recurrent theme that also emerged from a presentation on ultra-highfield MRI in humans. Jeroen Hendrikse (Utrecht, The Netherlands) demonstrated the latest advances in imaging perforating brain vessels and measuring blood flow in individual arterioles.

The workshop also tackled the issue of how to reduce the global burden of stroke. Rustam Al Shahi Salman (Edinburgh, UK) alerted the audience to major gaps in stroke prevention and the need to extend trials on ICH, ischemic stroke, and stroke prevention to low income countries. Saturday morning started with a series of talks illustrating how genetics and other omics technologies have transformed our understanding of diseases, changed disease classifications, and improved options for diagnosing and counseling patients. Anne Joutel (Paris, France) presented novel data showing that the phenotype in CADASIL transgenic mice can in part be reverted by altering the levels of Timp3 and Vitronectin, two extracellular matrix proteins that accumulate in the vasculature of CADASIL patients.

The meeting further included a session on stroke in the young and a lecture by Christopher Chen (Singapore) on “Cognitive testing in stroke: why, when, and how?” The conference closed with a hot topics session that presented 5 minutes talks against the clock.

While packed with scientific discussions there was still enough time for social exchange and recreation. Several people walked around the lake, went for a run, or took the cable car up to the Zugspitze. A young researcher commented “it was the best conference I have ever attended”.

Martin Dichgans and Heinrich Mattle
Chairmen of 3rd European Stroke Science Workshop

Please see also the results of the participants’ survey of the European Stroke Science Workshop 2015 which shows that it was a tremendous success.


Collaboration between ESO and EAN

Professor Kennedy Lees
ESO President
Professor Günther Deuschl
EAN President

EAN has joined with ESO to promote optimal management of stroke in Europe. EAN and ESO are the leading societies for neurologists and stroke specialists, respectively, in Europe. This new collaboration aims to enhance education, scientific endeavors, and build the critical mass of expertise to achieve excellence in stroke diagnosis, prevention, treatment and rehabilitation in Europe. Jointly, the two organizations will be able to lobby more effectively in Brussels for
harmonization of therapy of stroke and other neurological diseases and for strengthening funding for research on stroke in Europe.

The two societies have agreed to collaborate on the following specific activities to deliver this goal:

  1. Annual Scientific Conferences: establish permanent joint sessions at each other’s annual meetings and other relevant conferences,
  2. Best Practice Guidelines: nominate representatives for each other’s guidelines modules,
  3. Optimising Education: encourage attendance of members at summer schools, teaching courses and visiting doctor exchanges
  4. Liaison: encourage links with other relevant Societies.

The two societies’ mutual aspirations are complementary and fit well together. EAN represents Neurologists, for whom stroke is one area of interest amongst many other neurological disorders. EAN strives to provide high quality fully updated information from a subspecialist field to the "general neurologist". Strong working relationships with subspecialties enhances access to expert advice for guidelines and high quality speakers at conferences. ESO represents all stroke specialists, of which Neurology is one amongst many including Geriatrists, Stroke Physicians, Emergency Medicine Physicians, Neuroradiologists, Cardiologists, Rehabilitation Medicine Physicians, Basic Scientists, Nurses, Physiotherapists, Occupational Therapists, Speech therapists, Clinical Trialists, Epidemiologists, Public Health Physicians, etc. Strong working relationships with experts in a wide range of brain disorders helps to set stroke in context.“

For further information visit the following websites: ESO, EAN


ESO-EAST activities: report from meeting in Kiev, Ukraine

ESO has  recently launched  the 'Enhancing and Accelerating Stroke Treatment' (EAST), a 5-year project  aimed at improving stroke care and reducing the burden of stroke in Eastern Europe and Central Asia, with  the Ukraine one of 17 countries participating in the project. Three delegates, Drs. N. Chemer, D. Khramtsov and Y. Flomin, represented Ukraine at the first inaugural ESO EAST meeting in Glasgow on April 16, 2015 and upon their return home they came up with an Action Plan. Presently, the  Ukrainian Stroke Association (UStA) is  strong  and  professional, with  its leaders President Prof. Mykola Polishchuk and Executive  Director  Dr. Marina Gulyayeva, who  both  greeted the ESO EAST project with enthusiasm and offered to lend their full support.

According to the ESO EAST Ukraine Action Plan, on November 11, 2015 we welcomed to Kiev Dr. Valeria Caso, the ESO President Elect. We know of Dr. Caso's commitment to the project and looked forward to her visit by preparing a rich program. The first day of the two-day visit started with a Press Conference at UNIAN, the main Ukrainian Information Agency. At the Press Conference Prof. Polishchuk, acting as moderator, granted Dr. Caso the opportunity to introduce ESO and the ESO EAST project. Afterwards, leading Ukrainian stroke specialists shared their perspectives on the current state, unmet needs and expectations for stroke care in the Ukraine. The press conference and the ESO EAST project received wide coverage both in local and international media.

Resources in Ukraine

Resources in Russia

During the same afternoon, the ESO EAST Ukraine Steering Committee meeting was held. At the meeting, the ESO EAST Ukraine Steering Committee Board and Executive Group members had a detailed and productive discussion on the possibilities and challenges they face in reducing the burden of stroke in the country. Dr. Valeria Caso provided  the  group  with an  outline of  the ESO EAST project strategy, emphasizing that it was not ESO, but instead  local medical professionals  who  were  needed to lead in  the  enhancement of   national stroke care. Prof. Tamara Mishchenko, Chief Specialist in Neurology, and Prof. Eugen Pedachenko, Chief Specialist in Neurosurgery, the Ministry of Health of Ukraine, shared some data on stroke care structures and outcomes, as well as their take on ways to improve stroke care in Ukraine. Prof. Serhiy Moskovko reviewed his experience from setting up a local stroke registry in Vinnitska Oblast. Dr. Natalia Chemer, a Stroke Neurologist from Kyivska Oblast Clinical Hospital, reported on the first achievements in establishing a Stroke Unit network in Kiev Oblast. And Dr. Yuriy Flomin, the Head of Comprehensive Stroke Unit at Clinic 'Oberig', Kyiv, presented highlights from the second ESO EAST Meeting held on October 8-9, 2015 in Greece, including the set of variables to be collected for the ESO EAST Stroke Registry. Dr. Flomin highlighted that stroke registries were important tools for improving stroke care and outcomes, but were successful mainly in those European regions and countries where they were made mandatory. At the end meeting the participants discussed and accepted the resolution by the ESO EAST Ukraine Steering Committee. That night ESO EAST Ukraine Steering Committee members and their colleagues enjoyed a gala-dinner.

The following day, November 12, 2015, was the beginning of the annual National Stroke Forum 'Stroke Academy'. At the morning Plenary Session, Dr. Valeria Caso warmly greeted the attendees on behalf of ESO, confirmed the commitment of ESO in harmonizing stroke care throughout Europe, provided an overview of the ESO EAST project goals and encouraged Ukrainian stroke specialists to become more visible by actively taking part in ESOactivities and by submitting abstracts to the ESO conference and papers to the European Stroke Journal. Profs. Polishchuk, Mishchenko and Moskovko discussed in more detail the causes of high stroke mortality and disability in Ukraine, unmet needs in stroke care delivery and opportunities for enhancing and accelerating treatment of stroke in the country. Finally, Drs. Gulyayeva and Flomin presented the ESO EAST Ukraine Action Plan and reported on the first steps in the project. The audience of about 600 people welcomed the talks the ESO initiative.

In the afternoon Dr. Valeria Caso visited the Stoke Units where the two ESO EAST project delegates of Kyiv practice; first to the Kyivska Oblast Clinical Hospital and then to MC 'Universal Clinic 'Oberig'. During these short visits, Dr. Caso met with the stroke teams and encouraged them to keep on implementing the highest European standard of stroke care and apply for the ESO Stroke Unit certification.

We believe that these two days spent by the ESO President-Elect Dr. Valeria Caso in Kyiv, Ukraine, where she was able  to dialogue  with the local stroke community, were important as it  boosted the ESO EAST initiative and established closer ties to inspire Ukrainian colleagues. Many people have realized that now is the opportunity to alter the course of stroke, and we can all make a difference.


Interview Session


The future of stroke care: how much do we need „strokology” as a distinct medical discipline and what should it contain?

Stroke is a complex disease where neurological deficits are associated with vascular etiologies. Moreover, stroke patients suffer from several medical comorbidities and complications., Every year, more than 15 million people worldwide suffer a stroke, one third die and another third remain with major and permanent disability thus making stroke one of the main causes of mortality and the  leading cause of disability in adults.

Although there is a large consensus that stroke is best managed in stroke units, the stroke specialists include Neurologists, Internists and Geriatricians (to mention only the most common).  However, the ideal profile of a stroke specialist is still under debate.

We have performed an interview series by authoritative stroke field expert to bring this topic to your attention, which include Prof. Stephen Davis (University of Melbourne, President of the World Stroke Organisation) and Prof. Louis R. Caplan (Harvard Medical School, U.S.A.)  who authored the debate „Battle of the Titans”, dealing with the future of stroke care. This debate has been which published in Stroke (see below a list of links to the most relevant scientific publications related to „The Battle of the Titans”).

Selection of articles from „The Battle of Titans” and related to it:



Present and perspectives in acute stroke management:

  1. Worldwide, stroke specialist is not one single stereotyped figure. Neurology, Internal Medicine, Emergency Medicine, Geriatrics, to mention the most common, are the disciplines behind the stroke care, in your opinion what are the necessary requirements to be qualified as a stroke specialist?

  2. Could we still talk of a „Battle of the Titans” as in the old debate?

  3. Nowadays, do you believe we can identify „strokology” as a distinct medical discipline?

  4. What in your opinion is the distinctive feature/s of a „strokologist” from a general neurologist?

  5. Acute stroke management is a rapidly evolving field, we’ve reached a high level of standardised pathway of acute stroke treatment, and what do you think might be the next promising steps?

  6. If you should choose a single most important thing to improve the actual stroke care, what would it be? Would it be more determinant acting on population awareness, involving policy makers and institutions, changing training programs or improving technology?

  7. Do you think a stroke expert should be involved only in the acute stroke management or, also, in primary and long-term secondary stroke prevention?

  8. How do you see acute stroke management in the next years?

Tips for our youngest colleagues:

  1. How do you think a medical student can understand if he/she fits for a stroke-field career? How can we help them to make the right decision?

  2. Some advices for young doctors at their beginning in the stroke-field?


Prof. Louis Caplan, senior member of the Division of Cerebrovascular Disease at Beth Israel Deaconess Medical Center, Boston and Professor of Neurology at Harvard Medical School, Boston

Expertise in caring for patients with Cerebrovascular disease and stroke necessitates knowledge and training in internal medicine (cardiology, hematology, hypertension, pulminology, nephrology) and in the anatomy, pathology, and pathophysiology of cerebraovascular disease. This can be obtained by Neurologists who have training in Internal Medicine or by Internists who acquire additional training and expertise in Neurology or by having patients cared for in stroke units by both Internists and Neurologists. 

The material of strokology is highly specialized and few general internists and general neurologists are optimally trained and experienced in this field.

  1. See above- In depth training and experience in vascular disease (hypertension, cardiology, hematology) and in the anatomy, pathology and pathophysiology of the brain and vascular system and in diagnostic techniques that visualize the brain and its vascular supply.
  2. No. Internists and Neurologists can both qualify with the proper training and experience and co-operation with each other.
  3. Yes. We need many more well trained individuals.
  4. Special in depth knowledge of the clinical syndromes and causes and available treatments and their benefits and risks. Since treatment is often quick and decisions must be rapidly made- special training and experience separates the well trained strokologist from the ordinary Internist and Neurologist
  5. Standardized therapy- recipes check lists, and guidelines have limitation in treating individual patients. They are for novitiates not experts. They upgrade the weak but downgrade the true expert who rarely if ever uses them. We badly need more well trained, experienced stroke clinicians to make difficult therapeutic decisions.
  6. More stroke units in hospitals especially throughout the USA and in Asia.
  7. In all phases of care
  8. More specialized stroke units. More well trained stroke physicians and Neurologists. More dissemination of technology. More use of cell phones for conveying images.

Tips for our youngest colleagues:

  1. Exposure to stroke patients treated by stroke physicians during medical school and internship and residency.
  2. Be sure to do general neurology in depth while learning the nuances of stroke and cerebrovascular disease


Prof Laszlo Csiba is Professor and Head of the Department of Neurology at the University Debrecen in Hungary.

  1. The most important thing is to make sure that the qualification ’stroke specialist’ is only granted to physicians – potentially neurologists – who have spent at least 2 years working in a comprehensive stroke center which provides acute management, early rehabilitation, and follow-up care for at least 5–600 stroke patients annually, and has all the available diagnostic tools. The center is also supposed to operate with neurosurgical coverage and an intervention specialist on the premises. It is also crucial for applicants to take part in at least 2-3 duties per month (at the hospital, not on call) during the training.
  2. I wouldn’t like to comment on this question.
  3. In my opinion, a stroke specialist is defined as follows: apart from the neurological and neuroanatomical background, a stroke specialist has a thorough and detailed knowledge of the pathogenesis of vascular conditions, the diagnostic workup, acute management, secondary prevention and rehabilitation of ischemic and hemorrhagic stroke as well as stroke caused by subarachnoid hemorrhage, and has an at least 2-year experience in a comprehensive stroke center. A stroke specialist has a more detailed knowledge of imaging techniques and the management of coagulation and vascular risk factors, than a neurologist. Most importantly, a stroke specialist’s knowledge should be based on continuous practical experience.
  4. In Central and Eastern European countries, 60–70% of hospital beds are taken up by stroke patients in the majority of neurology departments. In the past few years, the diagnostic workup and management of stroke (lysis, mechanical thrombectomy etc.) have undergone revolutionary changes. Guideline recommendations cannot always be applied in real-life situations. The difference between a stroke specialist and a neurologist is that a stroke specialist has the kind of experience that allows for adequate therapeutic and diagnostic decision-making in situations that are not clearly covered by guidelines (some examples include acute stroke with acute or chronic coronary artery disease, multiplex vascular malformations, concomitant tumor, coagulation disorders etc.).
  5. Even in the United States, the rate of venous thrombolysis is under 10%. Although mechanical thrombectomy represents a significant progress in this field, the next breakthrough will be achieved when patients arriving beyond the time window (e.g. wake-up stroke) can be reliably classified based on the necessity for desobliteration. Unfortunately, I cannot expect rapid advances in the field of neuroprotective agents. As for my personal opinion the promising new agents (if we have such a drug in the future)  should be administered as prophylaxis for high-risk patients (e.g. after TIA) and not after stroke.
  6. I have several ideas. First of all, a comprehensive approach should be popularized regarding stroke prevention, which states that atherosclerosis is the common cause of peripheral arteriostenosis, coronary artery disease and stroke, therefore the management of risk factors reduces the risk of all vascular conditions. A health-conscious lifestyle and better compliance with medications. Educational programs that are not only organized in high-risk age populations but also at high schools. Teaching   at universities and colleges (and here I don’t refer to medical school), summarizing among others the important knowledge on oncologic and vascular conditions on a layperson level. Further advances could be achieved by equipping ambulances with CT scans, which would allow for the distinction between hemorrhagic and non-hemorrhagic strokes on the premises and prompt diagnosis, especially in polytrauma cases. Now that everyone has a mobile phone, it would be nice to have an application that could send an alarm to a stroke center if the owner’s speech changes, e.g. becomes dysarthric. There should also be applications that would loudly remind patients to take their medications from time to time or call attention to missed doses.
  7. The operation of an acute stroke center is ideal if it has regular contact with previous stroke patients. Prescriptions and regular check-ups should be performed by general physicians but patients should present at a stroke center at least every 6 months (especially patients with multiple comorbidities, and those with carotid artery stenosis). The stroke specialist of the stroke center should also monitor the quality of care provided by GPs.
  8. Transportation by helicopter and TeleStroke will become widespread in the following years, and comprehensive vascular intervention centers will be established that allow for the desobliteration of coronary and cerebral arteries and for intensive monitoring afterwards. I look forward to the development of thrombolytic agents that are more effective than t-PA. I expect a breakthrough in the field of hemorrhage, especially via the administration of tissue plasminogen activator or other thrombolytic agents into the hematoma.
  9. 20-30 years ago, medical students could only see stroke patients becoming confined to bed for the rest of their lives or dying. It is an incomparable, wonderful experience (especially for older generations that have seen hopeless times) when thrombolysis or thrombectomy ceases aphasia (our most important way of communication which makes us human) or paralysis, and the patient no longer needs the help of others. Medical students also need to understand that acute stroke management is becoming more and more individualized, a lot of patients do not fit into guidelines, and the physician’s deliberation will be crucial for making the best decision for the patient. Young physicians and medical students should therefore realize that stroke management is not about the routine application of treatment algorithms because personal knowledge and experience have a very important role in decision-making. A young physician who would like to work in the field of stroke should not start working in a secondary or tertiary center but a comprehensive, well-equipped center where all kinds of interventions are available, because this is the only place that covers the whole spectrum of the disease and the physician will not lose interest due to the less colorful work of secondary or tertiary stroke centers. The ever growing spectrum of diagnostic tools along with individualized therapy can provide an emotional factor which will raise the interest in becoming a stroke specialist for more and more medical students. They should also acquire knowledge in the field of neurosonology which could allow them to actively take part in the diagnostic workup. Those feeling the courage should also join interventional procedures which will grant them even more therapeutic success. As Christian Doppler wrote: ’the most rewarding thing for clinicians is when they find pleasure in what they do, and what they do is useful for mankind’.


Prof. Stephen Davis, Professor of Neurology, University of Melbourne

  1. There are a number of specialised backgrounds for an individual to qualify as a stroke specialist. Over and above standard clinical training for a relevant of specialty medicine (Neurology, Internal Medicine, geriatrics etc), the physician would require at least 12 months full-time training supervised by a recognised authorty in stroke medicine in a busy conprehensive stroke centre. This period should offer a thorough experience in stroke unit care, advanced imaging, thrombolysis and involvement of neuro-interventionsists, neurosurgery and vascular sugery in stroke management. Ideally, this should also involve a research project in an academic environment.
  2. I think the debate is over. An expert stroke physician could have a number of different specialty backgounds. Stroke medicine is not exclusive to Neurology. The important thing is their expertise in acute stroke management, which also involves a thorough knowledge of primary and secondary stroke prevention, stroke rehabilitation and also experience in leading a multidisciplinary srtroke team. They should ideally be involved in stroke research and education.
  3. I think that „Strokology” is a distinct discipline. It is based on the best principles of evidence-based medicine and requires a specialised training program.
  4. Neurology has become super-specialised. Although the general neurologist should be competent in the fundamentals of stroke care, the strokologist will have advanced training and expertise in all the aspects of stroke medicine. This is analagous to the head of a comprehensive epilepsy program, head of a movement disorders program, clinical neurophysiology or a mutile sclerosis expert.
  5. Endovascular thrombectomy is now proven and a huge challenge is now to make it an accessible therapy. This will ofetn involve a hub and spoke model between primary stroke centres and comprehensive stroke centres. I would predict that advanced brain imaging with CTP or MRI will allow treatment at later of uncertain time windows. I thinkwe will see major advances in the treatment of ICH. I think that hemostatic therapy for ICH is on the horizon and that the role of minimally-invasive surgery will be established for selected patients.
  6. It all hinges on education that stroke is preventable and highly treatable – focussing on all aspects of public, professional and public health policy. Training of stroke experts is crucial and of course treatment of all stroke patients in stroke units. Stroke unit care must be made available in all healthcare settings.
  7. These elements are all part of the spectrum of modern stroke care.A stroke expert will only be truly effective if they integrate and promote primary and secondary prevention
  8. I think we will see major changes. When I trained over 3 decades ago, there were no proven stroke therapies! We now have 5 level 1 acute stroke therapies (stroke unit care, tPA, acute aspirin, endovascular thrombectomy and hemicraniectomy. I predict further major advances in establishing the role of advanced brain imaging in patient selection,  treatment of ICH as two key examples

Tips for our youngest colleagues:

  1. The key thing is mentoring and inspiration. Ideally, the student should spend a period in a stroke unit. Stroke medicine is an exciting and evolving specialty. We can now prevent many strokes and really make a difference in rescuing brain and improving patient outcomes. There are wonderful possibilities for research and the satisfaction of leading a multidisciplinary team
  2. You can make a real difference and have a wonderful and rewarding career. It is difficult to imagine a more exciting field of internal medicine. You will be dealing with the second commonest cause of death worldwide, one of the leading causes of disability. Within the stroke field, you can subspecialise in clinical work (for example stroke prevention, neurointervention) and perform research in many aspects of stroke medicine.


Prof Miquel Gallofre Director at Health Department of Catalonia (Director de la Malaltia Vascular Cerebral), Barcelona/Spain

Discussing the fact as to whether “strokology” should be considered a medical discipline seems a relevant step to make at present, when demonstration of efficacy of mechanical thrombectomy has added further complexity to acute stroke care. Thus, strokology as a medical subspecialty would help improve quality of stroke care across Europe and, even more importantly, would contribute to homogenize practices across Europe, thus reducing variability of quality of stroke care. In addition, the tremendous interest on stroke in terms of number of European health professionals devoted to this discipline constitutes a critical mass that can clearly help in this process. Before addressing the questions, I would like to make some comments:

  • Care of patients with stroke is greatly influenced by characteristics of the health systems: private vs. public health systems (to just start off…), different disciplines from where strokologist come from in different countries (even within the same country there might be various options), different models of stroke units (some deal with patients in the hiperacute phase only while others include part of the rehabilitation process with longer stays and greater variation of stroke professionals involved). Thus, differences do exist across European health systems.
  • New advances in diagnostic and treatment areas are a reality in western countries but the situation is far from optimal in the rest of the world. Even within Europe huge differences exist. Awareness of the burden of stroke is still limited among citizens, institutions and governments and unfortunately at a great distance of what applies to other major diseases such as cancer or coronary heart disease. Thus, there is room for improvement.

1. As mentioned, professionals interested in developing a professional career as strokologists come from a variety of disciplines (neurology, internal medicine, emergency medicine, geriatrics, etc). It should be expected that health professionals taking a degree on strokology should follow a structured training program and work full time with stroke patients. For health professionals (GP, internists, geriatricians, etc) with interest in stroke, who deal with stroke patients not on a daily basis, there should be alternative ways of training or increasing knowledge aside of strokology.

2. Titans and Gods are very busy with climate crisis, fluctuation of Chinese stock market and oil prices. It’d be better that professionals working in stroke care get their own problems sorted out by themselves.

3. Strokology should be conceived as a medical discipline, structured as a subspecialty with a training system lasting over 2 years, with health professionals accessing this degree from different specialties. The degree should include all the topics related to stroke that are necessary for the management of stroke patients not only within the acute phase but in all different stages of the disease.

4. Neurology is the medical specialty from which most stroke experts come from. A general neurologist deals with dementia, Parkinson disease, multiple sclerosis, epilepsy, etc. Previous knowledge on the normal physiology and pathophysiology of brain diseases should be clearly helpful (even necessary) for strokologists but they should get trained in other disciplines (cardiology, neuroradiology, physiotherapy, speech therapy, etc…)

5. Improvements in new diagnostic procedures and treatments in the acute phase of stroke will surely occur in the next years, but the most challenging improvement at the European level should to be organizational, oriented to assure widespread implementation of these measures.  Timely access to reperfusion treatments is clearly related to available ambulances, helicopters, the state of the roads, the available professio9nals and technical resources to triage patients with suspected stroke, etc… barriers to the implementation of convenient organizational measures are surely different between eastern and western European countries.

6. Undoubtedly, involving policy makers and health administrations and supporting National Stroke strategies and Regional Stroke Programs both oriented to place stroke where it deserves to be are must-haves. Special characteristics of stroke made necessary to increase population awareness. There is still much work to do on this issue
7.  A strokologist should be a super stroke expert, thus fully competent to deal with issues related to the acute stage, primary and secondary prevention and even, in some countries, should be capable to coordinate the rehab stage.

8. Evolving rapidly. New evidence in endovascular treatments is the first step for a challenging future only as with improvements that will happen surely in other fields of the stroke care. It is very important that organizational measures follow scientific evidence thus allowing these improvements to be widely implemented in all countries

9. I do not know what the reasons are for a medical student to decide a medical specialty. Supposing that they could really decide what they want, it seems logical that more weight has the specialty; more chance has to be chosen

10. You have made the right decision. Work very hard!


Prof. Didier Leys, Professor of Neurology at the University of Lille, and a former President of the European Stroke Organisation.

  1. To be qualified as a stoke specialist a physician needs knowledge of

    • brain anatomy, brain physiology, and cerebral (and spinal) blood supply.
    • symptoms, signs, and diagnosis of other neurological disorders that may represent stroke mimics
    • interpretation of CT and MRI in emergency in stroke patients and for potential mimics
    • neurological symptoms that represent potential stroke complications (seizures, dementia, depression, pain …)
    • prevention, diagnosis and emergency treatment acute and chronic cardiac, vascular and pulmonary conditions that are frequent in stroke (atrial fib, cardiac failure,  pneumonia, DVT etc)

  2. A bit outdated nowadays, 12 years after this publication. 
  3. Strokology is part of neurology. However, that does not mean that all neurologists are able to manage stroke, and on the other hand that only neurologists can treat stroke patients. 
    Strokology is an hyperspecialisation, and to be strokologist it is possible to come from the neurological field (most frequent case), but also from emergency medicine, internal medicine or rehabilitation. I am personally more reluctant to include geriatrics here, when a significant number of stroke patients are below 65 years of age.
  4. The distinctive features are

    • Being used to emergencies
    • Being trained for “internal” disorders frequent in strokology (atrial fib, pneumonia, DVT, etc)

  5. Improving delays with new technologies for diagnosis and communication (telemedicine, prehospital management etc), and education

    • Prehospital selection of patients who should be sent straight to a stroke unit with interventional radiology and who should not
    • More widespread use of mechanical thrombectomy, and even improvement of iv thrombolysis rates where there is still place for improvement
    • Hypothermia may be a step (under evaluation)

  6. Public awareness is essential. You may have the best technology, the best physicians, the best prehospital management, but this will be completely unuseful if patients call 24 hours later.
  7. Acute management : yes
    Secondary prevention: yes
    Primary prevention: in limited aspects of very high risk patients only (ex asymptomatic carotid stenosis etc)
  8. Patients will arrive earlier

    • Broader place of thrombectomy
    • Ideal : thrombectomy available in all stroke units on site
    • Pre-hospital thrombolysis but not everywhere (in areas where it provides extra benefit, not in a dense area with a stroke unit every kilometre!)
    • Still a small increase in thrombolysis

  9. Work for a while in a stroke unit and decide after
  10. Be well trained in neurology

    • Have a training in cardiology and intensive care (not in all fields but in those useful for a stroke physician)


If you have any topic you may want to debate please send your suggestion to
Florin Scarlatescu (PR Committee) at the following email address:

ESO Department-to-Department Visit Programme


APPLICATION DEADLINE – 28 February of each year


  • The programme is offered to young physicians and scientists to support a short visit of 1 week to a European department or laboratory, or as contribution a to longer visit
  • ESO will support up to 4 young physicians/scientists annually with a grant of maximum 1.000 euros per applicants


  • To provide insight into stroke departments outside your country
  • Establish contact with centres with potential for future research and job opportunities


  • Physicians or scientists < 35 years of age
  • Interest in the field of stroke
  • Applicants are expected to become ESO members (Junior membership, free of charge - membership application is available here).


  • Complete this application form (here)
  • CV ( 1 page)
  • List of publications
  • Letter of recommendation from Head of Department of proposed institution
  • Letter of motivation (1/2 page)
  • Copy of identity card/passport

Applications must be submitted to the ESO Secretariat

by e-mail to by February 28 of each year.

For any questions please write to


BJNN Stroke Journal digital ‘flick-book’– accessed through this link:

ESO Activities

ESO Conference: The second Europe-wide conference will be held from May 10th to 12th 2016 in Barcelona. Information is available on the conference website at For further details, you may contact Marcel Dekker (, or Prof. Kennedy Lees ( Please note that the «European Stroke Conference (ESC)» is not supported by the ESO.

ESO Industry Round Table: To become member of the ESO Industry Round Table, i.e. a regular sponsor of ESO, please contact Daniela Niederfeld at  You will be mentioned on the ESO website where you may discover several of the other activities described below. Industry Round Table meetings usually take place twice a year during stroke conferences. For further details, you may contact Daniela Niederfeld at, or Prof. Natan Bornstein at


ESO Summer School is organised for ESO each year by a team of stroke physicians in a European city. During one week, stroke specialists from Europe provide their expert knowledge to young physicians with a major interest in cerebrovascular diseases. For further information please see the ESO website at

This year´s Summer School takes place from July 18th – 22nd in Madrid, Spain. Please see their website for further information.

In 2015, the summer school took place from August 24th to-28th in Hradec Králové, Czech Republic. The report of this Summer School is published on the ESO website.
ESO-ESMINT-ESNR Stroke Winter School 2016 will take place in Berne from February 9th to 12th , it is mainly focused on  mechanical treatment for acute stroke and interventional neuroradiology, for further information please contact Prof. Urs Fischer ( or check the website at

Establishing endovascular stroke management is one of the major challenges in acute stroke treatment. The aim of the ESO-ESMINT-ESNR Winter School is to join young stroke physicians and young neuroradiologists in order to enhance interdisciplinary management of patients with acute ischaemic stroke. The ESO organizes together with ESMINT and ESNR a winter course for young stroke physicians and neuroradiologists on this topic.
The 2nd ESO-ESMINT-ESNR Stroke Winter School took place in Berne, Switzerland from February 2015. More information is available here...


European Stroke Science Workshop is held every two years.  Next appointment will be in 2017.


ESO-Karolinska Stroke Update Conference is held every two years in Stockholm. The next one will be held in November 2016. The current recommendations are available on and For further details you may contact Prof. Nils Wahlgren (


European Master Program in Stroke Medicine is a full Master's course promoted by ESO with the support of  the WSO. All fields of stroke management and therapy are covered by a distinguished Europe-wide faculty of stroke experts. Starting biannually at the Danube University Krems, Austria. For further information please see here. You may also contact Mrs. Bettina Denk ( or Prof. Michael Brainin (


ESO-EAST ("Enhancing and Accelerating Stroke Treatment“) project, supported by independent and unrestricted educational grants from EVER Pharma and Boehringer Ingelheim, aims to establish a 5-year collaboration with selected physicians from Eastern countries to optimise stroke care in Eastern Europe. A first workshop was held in Glasgow during the European Stroke Conference 2015.

Topic-specific workshops: ESO regularly runs workshops on stroke outcomes, analytical approaches to outcomes and update on devices in stroke, with several publications to date, and has had impact on FDA acceptance of ordinal analysis approaches to acute trials. The next workshop will be held before the ESO Conference in May 2016 in Barcelona. You can find information on past workshops on the ESO website at and


ESO Guidelines : ESO has been the scientific society in charge for the production of the European Stroke Guidelines, published in many languages. They are currently being updated and will soon be available also in  App modality for smart phones.

Upcoming ESO Events

3rd ESO-ESMINT-ESNR Stroke Winter School: 9th to 12th February in Bern, Switzerland

Industry Roundtable Los Angeles, Friday 19 February 2016

The 2nd European Stroke Organisation Conference (ESOC 2016)
May 10-12, 2016 - Barcelona, Spain
Summer school 2016, 18-22 July 2016 in Madrid,
Please visit the their website

Other Events, endorsed by ESO

10th Portuguese Stroke Congress
4-6 February, 2016 - Porto, Portugal

Flemisch neurovascular course for nurses and paramedics
(Opleiding Neurovasculaire zorg voor verpleegkundigen en paramedici)
April 15, 2016 - Brugge, Belgium

1st Congress of Cardiovascular Prevention in Pre-Elderly and Elderly Individuals (CPPEI 2016)
30 June - 2 July, 2016 - Bratislava, Slovakia

10th World Stroke Congress
October 26-29, 2016 - Hyderabad, India

New: ESO Ambassador

ESO has excellent relations and collaborative agreements with numerous sister organisations around the world, including WSO, APSO, the SSA, the EAN, the European Society for Cardiology, ESMINT, ESNR, SAFE, etc. Many of these societies organise joint symposia with ESO at ESOC, but also hold reciprocal sessions in their own conferences.

Would you like to take an active role in ESO and are you interested to give lectures within a joint symposium? If you are interested in joining a pool of possible ESO Ambassadors, then please indicate your interest here.

ESO membership

The current ESO membership numbers are as follows (as of 20.01.2016): Regular members: 877, Fellow member: 164, Junior members: 219, Organisational member: 31. Total: 1.291 members.

We cordially welcome all new members to ESO!

Please help to further promote membership in the ESO by talking to your colleagues and students. Membership registration is available on the ESO website:  If you are already ESO member you might want to consider upgrading your membership to Fellow membership. Further information is available at
Please also make sure that you pay your annual membership fee. Timely payment of membership fees secures reliable income for our organisation. This is important to keep ESO up and running and to be able to plan future activities! Membership fees can be paid online at Thank you!



AHA/ASA Professional Membership

Join a network of more than 27’000 professional members by affiliating with the AHA/ASA Stroke Council. Read more.


AHA Webinars

In 2011, Stroke initiated a series of educational webinars that occur on a bimonthly basis. These webinars cover important topics in the cerebrovascular disease field, especially those with recent advances that will impact clinicians and researchers. The intention of the webinars is to provide participants with current and novel information on high-impact topics. The webinars consist of a structured lecture with appropriate slides by acknowledged thought leaders relevant to the topic under discussion. For the live webinar, participants then have the opportunity to pose questions to the speaker after the formal presentation. These webinars serve as a valuable educational resource to the stroke community for enhancing knowledge about recent developments in this evolving field.

ESO offers in collaboration with the American Stroke Association (ASA) free webinars accessible via the ESO website. Please click here to access the webinars.

Donate to ESO

The European Stroke Organisation appreciates any donation which helps funding important projects and supporting various activities with the goal of raising the awareness of stroke on a pan-European scale. Please tell your colleagues and executives at the hospital about this new opportunity to make a difference in stroke, by supporting our organisation. Your donation will help us in our efforts to reduce the number of stroke-associated deaths and the burden caused by stroke throughout Europe. Please visit the ESO donation website at Every support is highly appreciated and we thank you for caring!


Join ESO on Twitter

Register on Twitter at and to become a Follower of ESO!

Anything interesting you would like to share with the ESO community via Twitter?

Please contact Else Charlotte Sandset from the ESO Public Relation and Young Stroke Physicians Committees at Contributions might include scientific content, such as interesting papers on stroke, information on stroke meetings and ESO initiatives as well as pictures from ESO events or even clinical trials results as they are given at conferences.

Below is a selection of latest Tweets posted by Else Charlotte Sandset.

Wishing you all a Happy New Year! We are looking forward to an exciting 2016 with the launch of the ESO journal and #esoc16 in Barcelona!

Want feedback from experts @ESOC2016? The Young Stroke Physicians session invites young investigators to present planned projects! #ESOC16

#ESSW15 has come to an end! We look forward to more stroke, science, socialising and sun @ESOC2016, Barcelona in May! See you there! #ESOC16

Rise and shine for the final day of #ESSW15! We look forward to more excellent updates @BleedingStroke, @hoygarden and @RuttenJacobs!

ESO Newsletter

We encourage everyone to submit contributions to future ESO newsletters by sending your suggestions, comments or scientific news to Paola Santalucia, ( Also, ESO fellows are kindly invited to send a short summary of their recent relevant publications to the same above email address.

ESJ – European Stroke Journal

In October, ESO President Kennedy Lees announced the launch of ESO‘s own journal, the European Stroke Journal (ESJ). It is fully peer-reviewed and will be submitted for Committee on Publication Ethics (COPE) membership upon publication of the first issue. Issues will be published 4 times a year (March, June, September and December) with 96 pages in each issue. Articles will be published online first prior to issue publication. Subscription of the European Stroke Journal is included in the ESO membership fee.

The journal is owned by the ESO and published by the highly reputable publishing company SAGE. SAGE publishes a series of medical and scientific journals, is known for its ethical approach.

TheEditor-in-Chief is Bo Norrving, from Lund in Sweden.

Bo Norrving
Bo Norrving is Professor in Neurology at Lund University, Sweden. He has broad experience in stroke, from clinical research (including many seminar papers and books), publishing (associate/senior consulting editor positions for Stroke and Neuroepidemiology), stroke society leadership (past vice President of the ESO, immediate-past President of the World Stroke Organization), to governmental/ policy positions. The latter include acting as chair of stroke section for ICD 11 at WHO, the WSO Global Policy committee, the Swedish Stroke Register (Riksstroke), and co-chair of the WSO Guidelines and Quality Committee.

The Vice Editor is Didier Leys from Lille in France.

Didier Leys
Didier is Professor of Neurology at the University of Lille, and a former President of the European Stroke Organisation. He has a long history of collaboration in the stroke field within Europe, especially with Finland, Germany, Switzerland and Italy. Didier’s research activity has 3 main orientations: the relationship between stroke and dementia, mechanisms of cervical artery-dissection, and thrombolysis in acute cerebral ischaemia. He has authored 466 publications attracting 15,541 external citations. His served for 7 years as associate Editor of the Journal of Neurology, Neurosurgery and Psychiatry (April 2004-March 2010), and has been editorial board member and reviewer for several other journals.

We need your active support for the journal in multiple ways: by submitting your best science in the stroke field to the European Stroke Journal, by providing rapid and careful reviews when asked for, by citing the European Stroke Journal publications in your own manuscripts, by spreading the information of the journal to your colleagues, and by promoting the journal in social media. We count on your full support from the very start.

Click here to submit your manuscripts

The European Stroke Journal covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor.