LAUSR

The incidence of young stroke appears to be increasing. In this modern world where flexibility in the work place is much more accepted, we should be able to increase the number of people with stroke who return to work. This may also embrace concepts such as working from home remotely which may be ideal for people with disability. Interestingly, Edwards et al. and their interesting systematic review of the subject showed that there is a steady increase in the proportion of young stroke survivors with median frequency increasing from 41% between 0 and 6 months, 53% at 1 year, 56% at 1.5 years to 66% between 2 and 4 years post-stroke. Apart from the intellectual benefits of returning to work, there are obvious social benefits when returning to an environment where people may have life-long friendships. Health economic benefits should also be considered given that a return to the workforce has a positive impact on the economy of any country where individuals move from being a welfare recipient to a tax paying contributor. The factors which may predict return to work are reasonably well understood but much work needs to be done to improve the participation rates, earlier if possible. Interestingly, sudden death in young people due to stroke was shown to be approximately 3% of all sudden death cases, the majority of which are hemorrhagic in etiology. This figure comes from an interesting Danish study (Agesen et al.), where all cases of sudden death were identified over a decade. An important finding was that a high proportion of these had preceding neurological symptoms which suggest there may be an opportunity to minimize the likelihood of this tragic outcome. Prevention of stroke at any age should be a major research thrust; the Norwegian group present us with additional data on hemodynamic factors which may predict long term stroke risk in healthy middle-aged men, which include a number of blood pressure variables, including maximal systolic blood pressure heart rate during exercise. Clearly, we are becoming more sophisticated when identifying risk factors and need to educate physicians and the general public on strategies to address these modifiable factors. Food for thought; and this is even before we consider the intriguing subject of stroke while driving!