Michael Bodo

Hungarian Stroke Program: 1988–2006

Approximately 50 000 acute stroke emergencies occur annually in Hungary, about 20 000 are fatal within 30 days, making stroke the third most common cause of death in Hungary after heart attack and cancer (1, 2). From 1988 to 1994, despite political and economic changes and limited financial resources, efforts by a small group of physicians evolved into a modern, comprehensive system for treatment of stroke victims. From 1990 to 2004, stroke mortality decreased in Hungary from about 240/ 100 000 to about 180/100 000, and cardiovascular mortality increased slightly (3). In 1988, a group of neurologists attending a meeting in Gyor, Hungary, issued a mandate to decrease stroke mortality. At that time, it was highly unusual for a nongovernment entity to address a public health problem in Hungary. As a result of the meeting, a threemember leadership/organizational committee was appointed, they then set up a foundation, initiated free postgraduate education in stroke treatment, conducted a survey to assess stroke treatment in Hungary, and formed stroke units in several hospitals. In 1988–1989, the Cerebrovascular Section of Hungary’s Neurological and Psychiatric Society was created to increase the number of medical doctors involved in the care of stroke patients. The objectives were to include physicians from a variety of specialties (neurology, internal medicine, radiology, angiology) and to provide free postgraduate education through scientific meetings, research seminars and case presentations. The group provided the first postgraduate education for stroke neurologists in Hungary. Expert researchers and clinicians from several universities (Budapest, Debrecen, Pecs and Szeged) and the National Institute of Neurosurgery gave guest lectures at no cost to participants. Semmelweis University Medical School provided classrooms. Conferences were held at government sites, and a satellite symposium of the International Society of Cerebral Blood Flow and Metabolism was organized in Budapest (1989).

Prevalence of stroke/cardiovascular risk factors in Hungary

A cross-sectional survey was conducted in Hungary using the Cerberus system which includes: 1) a questionnaire addressing the risk factors for stroke/cardiovascular disease; 2) amplifiers to record the pulse waves of cerebral arteries (rheoencephalography) and peripheral arteries, electrocardiogram and electroencephalogram. Additionally, subjects were measured for carotid stenosis by Doppler ultrasound and 12-lead electrocardiogram; subjects were also screened for blood cholesterol, glucose, and triglyceride levels. Prevalence of the following stroke risk factors was identified: overweight, 63.25%; sclerotic brain arteries (by rheoencephalogram), 54.29%; heart disease, 37.92%; pathologic carotid flow, 34.24%; smoking, 30.55%; high blood cholesterol, 28.70%; hypertension, 27.83%; high triglyceride, 24.35%; abnormality in electrocardiogram, 20%; high glucose, 15.95%; symptoms of transient ischemic attack, 16.07%; alcohol abuse, 6.74%; and diabetes, 4.53%. The study demonstrates a possible model for primary cardiovascular disease/stroke prevention. This method offers a standardizable, cost effective, practical technique for mass screenings by identifying the population at high risk for cardiovascular disturbances, especially cerebrovascular disease (primary prevention). In this model, the rheoencephalogram can detect cerebrovascular arteriosclerosis in the susceptibility/presymptomatic phase, earlier than the Doppler ultrasound technique. The method also provides a model for storing analog physiological signals in a computer-based medical record and is a first step in applying an expert system to stroke prevention.