Role of scientific societies in implementation of stroke guidelines and clinical pathways promotion

Both inpatients and outpatients affected by cerebrovascular diseases currently request various clinical expertise, mainly expressed by specialties involved in neurological and in cardiovascular topics. In many cases each specialty tends to assume a leading role in proposing guidelines minimising the aspects not commonly treated; the SPREAD experience allowed a valid cooperation and the confluence of selective opinions toward the goals of stroke care and the clinical decision supported by evidence. In the last years, some hospitals proposed a stroke clinical pathway performed on the basis of integrated actions of all specialists involved in stroke care. The organisation core is the stroke unit but a strong point is represented by the relationship with the emergency system and the post-discharge organisation. The Italian Stroke Forum is a scientific society linking several specialties, approaching different aspects of cerebrovascular disease, ranging from epidemiology to pathophysiology, diagnosis, medical and surgical treatment, and rehabilitation. For these characteristics the proposed guidelines published in SPREAD are accepted by 34 scientific societies and are largely adopted as the scientific background of the stroke clinical pathway. The Cerebrovascular Disease Association, was proposed as a Study Group of the Italian Neurological Society, has a similar organisation regarding the different neurological aspects involved in stroke care, from neuroepidemiology to neurorehabilitation. Recently, the American Board of Medical Specialties approved a Certification in Vascular Neurology as a new subspecialty requested by the American Academy of Neurology; maybe in the near future a Consensus Conference has to be organised in Italy also, with the aim of defining a common management of stroke and promoting the growth of vascular neurology disease as an independent area of medical expertise.