[The skill of the stroke physician and the acquirement method]

A stroke is an emergency disease and a battle against time. Therefore we do not have long time to evaluate neurological evaluation. Neurologic evaluation is the most important process for the diagnosis of stroke patients. When we see stroke patients, we assess neurological findings and suspect the responsible brain lesions and artery before neuroimaging studies. This process is very important for not only stroke specialists, but also neurologists and NIHSS score is widely used as stroke score for neurological severity. Specially, when stroke patient is treated with t-PA, NIHSS score is used as inclusion or exclusion criteria for t-PA therapy. Examinations that stroke physician should acquire are neurosonography such as TCD, TCCS, carotid echo, and echocardiography, MRI and CT as neuroimaging, and cerebral angiography, and perfusion MRI, SPECT and PET as brain perfusion. In particular, the diagnosis of brain MRI and CT is essential, and cerebral angiography and ultrasound is important for the physician. SPECT, PET, and the perfusion MRI can evaluate the brain perfusion. IV-t-PA therapy and endovascular therapy are very important for stroke patients. Therefore, skills related to IV-t-PA therapy and endovascular therapy are necessary for acute stroke treatment. A neurologist treating stroke patients must acquire the above skills.