OBJECTIVE: This is a natural history/disease pathogenesis protocol for evaluation of patients with or at risk for acute stroke, transient ischemic attack (TIA), or other disturbances of cerebrovascular circulation. The purpose of this protocol is to generate natural history data to serve as the basis for future hypothesis-driven protocols as well as to contribute to the clinical and physiological understanding of cerebrovascular disease through the description of disease manifestations and the relationship among clinical, hematologic, and radiologic variables, as well as identifying potential subjects for future studies on stroke and other cerebrovascular diseases. STUDY POPULATIONS: Patients will be recruited from the collaborative stroke program between NINDS and affiliated hospitals and will be followed for the duration of their hospitalization. Select subjects will then be seen for follow for up to one year. DESIGN: Clinical issues to be addressed will include disease manifestations, natural history, acute disease management, and psychological/behavioral impact of the disease. Because of the nature of acute cerebrovascular disease, it is important to note that the research performed under this protocol will not interfere with emergency clinical evaluation or treatment of subjects, as specified in the clinical care pathway in place for the standard care of stroke patients at participating hospitals. Due to the emergency nature of clinical evaluation and therapy for stroke patients, waiver of written informed consent in certain circumstances for minimal risk procedures during acute period (e.g., collecting extra tubes of blood during initial phlebotomy for emergency room blood tests) will be required when it is impossible to obtain consent prior to critical emergency treatment procedures that may change the values of the variables. Patients will not be treated with experimental therapies as part of this protocol. Data collected under this protocol may be shared with other NIH researchers and databases and the National Institutes of Neurological Disorders and Stroke (NINDS) Repository if the subject approves this option in the informed consent. OUTCOME MEASURES: In addition to clinical, imaging and laboratory data that are part of routine clinical care of the patient, a variety of outcomes will be collected, e.g., infarct volume, clinical outcomes on NIH Stroke Scale, modified Rankin Score, Barthel Index, blood marker of inflammation, coagulation and gene expression. Statistical analysis plans will be developed as specific questions and hypotheses are generated.
- INCLUSION CRITERIA: 1. Age greater than 18 EXCLUSION CRITERIA: 1. Patient is less than 18 years of age. 2. Subjects with contraindication to MRI scanning will be excluded from any testing which involves the use of MRI. These contraindications include subjects with the following devices or conditions: 1. Central nervous system aneurysm clips; 2. Implanted neural stimulator; 3. Implanted cardiac pacemaker or defibrillator; 4. Cochlear implant; 5. Ocular foreign body (e.g. metal shavings); 6. Insulin pump; 7. Metal shrapnel or bullet; 8. Any implanted device that is incompatible with MRI. Subjects with a condition precluding entry into the scanner (e.g. morbid obesity, claustrophobia, etc.) will not be included in the MRI portion of this study. Pregnant women will be excluded from testing which involves the use of MRI. 3. Subjects will be excluded from 7T imaging if they are at risk of aspiration or have any condition that may require precipitous removal from the scanner.