The Brazilian Society of Cerebrovascular Diseases – history

ABSTRACT The present article provides the historical background of the Sociedade Brasileira de Doenças Cerebrovasculares (Brazilian Society for Cerebrovascular Diseases), including details on its function, structure, challenges and main achievements.


BEGINNINGS
The Cerebrovascular Diseases Working Group was set up in 1982, under the leadership of Prof. Dr. Roberto Melaragno Filho, an eminent neurologist deeply involved with cerebrovascular diseases. Professor Melaragno was tasked with the initial structuring of the group of neurologists interested in cerebrovascular diseases. This working group had the following coordinators, with two-year tenures: [1982][1983][1984]  The working group was active but the need for greater involvement of specialists became clear. Few neurologists were interested in cerebrovascular diseases and the level of communication and tasks was lower than we wished. We recognized the need to solidify studies of cerebrovascular diseases; we needed to be more connected and to encourage neurologists to join our working group.

Creation of the SBDCV
Early in 1994, the board of the working group established new directions, widening the scope of the working group, and proposed setting up the SBDCV to address the above-mentioned challenges. Initially, all members of the ABN were sent a letter (Figure 1) about the creation of the SBDCV, informing them that this would be part of the Cerebrovascular Diseases Working Group, contribute to the ABN and comply with all regulatory rules. The beginning of 1994 marked the actual founding date of the SBDCV, while the society was formally instituted on the September 16, 1996, following its registration at the notary public office ( Figure 2) and approval of the decision on its constitution at the Annual General Meeting of the working group held in Curitiba during the XVIII Brazilian Congress of Neurology. At this time, a call to all ABN members was made. At the AGM, the articles of incorporation, and the setting out of the main objectives of the SBDCV, were approved ( Figure 3).  Another important discussion at the meeting was the analysis of the best name for the disease, since some advocated "encephalic vascular accident" as opposed to "cerebrovascular accident"; the meeting elected the best terminology to be: "cerebrovascular accident", as this was more widely recognized and used.

Challenges and support
Although the articles of incorporation state that the SBDCV would be the working group of the ABN, abide by its regulations and would evolve within the ABN, there were reservations on the part of the ABN involving concerns over separate growth of the SBDCV and its consequent distancing from the ABN. This was not the intention of the new society, yet this concern almost led to the demise of this fledgling association. At the time, there was pivotal support from Professor Antonio Spina-França Neto, a former president of the ABN and one of the most respected neurologists, who backed the continuation of this idea. Professor Sérgio Novis then also supported the idea of setting up the SBDCV, which took shape little by little.

Directors of the SBDCV
The management boards of the SBDCV, from its founding to the present day, have had the following presidents: 1996

Main actions of the SBDCV
The SBDCV has carried out a range of activities, with key actions including: national consensus, congresses, teaching books, collaborative national and international studies, and the heading of campaigns on awareness, prevention and rehabilitation of stroke in Brazil.
The first communication disseminated by the SBDCV was the publication in the form of a four-monthly information release called the "Newsletter", starting in January 2004, and containing abstracts of studies and research, local and international news, congresses, opinions of colleagues, etc. This initial milestone was fundamental for the ABN and SBDCV and prompted other publications, including those in other neurology subspecialties.
A number of book titles were released, under the SBDCV, on topics such as: cardiovascular diseases, management approaches; approaches in the acute phase of stroke, and Stroke Brazil.

Congresses of the SBDCV
The Annual General Meeting of the ABN in Curitiba (1996) approved the holding of the biannual Brazilian Congress on Cerebrovascular Diseases. It was decided to hold the first congress in São Paulo, November 13-15, 1997, in which 426 delegates took part, including eight overseas invitees. This represented a strong foundation and provided encouragement for further events, which have been held regularly ever since. To date, the following congresses have been held:

Consensus and guidelines of the SBDCV
Another highly-important activity performed by the SBDCV is the devising of "Consensus" and "Guidelines".  Endovascular treatment (mechanical thrombectomy) -2017 8

Stroke prevention programs
One of the purposes of the SBDCV is to raise the awareness in the lay public of the importance of recognizing a stroke, risks of having a stroke, how to prevent it and how to proceed in the event of a stroke. This has been achieved via talks for the public and publications, but mainly through participation in the "World Stroke Day" campaign 9 . This is an international activity coordinated by the World Stroke Organization, in which the SBDCV is engaged and coordinates nationally. This has been held annually, uninterrupted,

Contributions to the Brazilian Ministry of Health and to the Federal Board of Medicine
Given its main objectives of prevention and proper treatment of stroke in Brazil, since its founding, the SBDCV has worked with the Brazilian government to collaborate in the implementation of regulations and actions on this front. We were involved in the drafting of numerous important regulations, including those on guidelines for diagnosing brain death 10 , line of care in stroke 11 , rulings 664 and 665 on thrombosis, and on the establishment of stroke units 12,13 . Another conquest was the inclusion of neurologists in the group of interventionists.
In parallel, the SBDCV has played an active role in lobbying for improved public healthcare for stroke patients in Brazil 14 .

Other activities
There are several groups that have been working on providing new data on the epidemiology of stroke in Brazil. Dr. Norberto Cabral is one of the leading members of this group, with important contributions. His papers have contributed to a better understanding of the social disparities of our stroke patients, and the alerting of the International Stroke Society.
The relationship with the Ministry of Health began in 2008, with Dr. Sheila Cristina O. Martins as the lead person. She has made major contributions to improving stroke awareness among politicians and the Brazilian population, as well as fostering the inclusion of tPA as treatment of acute ischemic stroke by the National Healthcare System of Brazil.
Transcranial Doppler ultrasonography has a leading person in the country. Dr. Viviane Zétola has made several contributions, including the certification of neurologists to perform the technique.
The inclusion of intensive care as an area closely connected to cerebrovascular diseases in the Society has been an important achievement. Drs. Jamary Oliveira-Filho and Gisele Sampaio Silva are two major leaders who have helped in this approach.

FINAL COMMENTS
This article outlines some of the SBDCV's activities and its path to success, which have contributed to further studying of cerebrovascular diseases in Brazil, and consolidated our position in relation to international organizations. The journey of the SBDCV will be long-lasting and ongoing, given the collaboration of renowned colleagues and the new values they bring to the Society. The SBDCV shall continue to grow, while maintaining its important role in national and international Neurology.