Neurology India
Open access journal indexed with Index Medicus
  Users online: 453  
 Home | Login 
  About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe Etcetera Contact  
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (592 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   Article Figures

 Article Access Statistics
    Viewed435    
    Printed0    
    Emailed0    
    PDF Downloaded10    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
CORRESPONDENCE
Year : 2017  |  Volume : 65  |  Issue : 2  |  Page : 441-442

Stroke health and research initiatives – Advanced stroke care model and future roadmap


Department of Radiodiagnosis (Neuroradiology), CMC Hospital, Ludhiana, Punjab, India

Date of Web Publication10-Mar-2017

Correspondence Address:
Shriram Varadharajan
Department of Radiodiagnosis (Neuroradiology), CMC Hospital, Ludhiana, Punjab
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/neuroindia.NI_884_16

Rights and Permissions



How to cite this article:
Varadharajan S. Stroke health and research initiatives – Advanced stroke care model and future roadmap. Neurol India 2017;65:441-2

How to cite this URL:
Varadharajan S. Stroke health and research initiatives – Advanced stroke care model and future roadmap. Neurol India [serial online] 2017 [cited 2017 May 23];65:441-2. Available from: http://www.neurologyindia.com/text.asp?2017/65/2/441/201872


Silent epidemics of stroke and cerebrovascular diseases are increasingly afflicting younger populations, and thereby, the bulk of our economic workforce. Previous models have been suggested for developing countries with an emphasis on prevention of stroke and increasing community awareness regarding various factors that help in preventing it. However, equal importance needs to be given to the treatment of cerebrovascular emergencies to improve clinical outcomes and to provide functional independence. Current terminologies and treatment guidelines are ambiguous, leading to their suboptimal management and poor outcomes.

Stroke, by definition, includes both ischemic and haemorrhagic types, with differing management approaches. Ischemic stroke is primarily managed by medical treatment with recent emphasis on advanced endovascular management in carefully selected patients through relevant neuroimaging. Early surgical decompression has shown to improve outcomes in malignant infarcts. Primary intracerebral haemorrhage requires blood pressure control with surgical decompression for relief of mass effect. Aneurysmal subarachnoid haemorrhage requires dedicated neuro-critical monitoring along with microsurgical clipping or endovascular coiling. Clearly, stroke and cerebrovascular diseases require a team of dedicated neurovascular physicians, cerebrovascular surgeons, neuro-interventional radiologists, and neuro-intensivists.

Time has come to recognize and bring together these varied specialists involved in treating these complex diseases under an integrated Department of Stroke Medicine and Cerebrovascular Surgery. These departments need to be started initially in all the major institutes having advanced facilities as a part of Stroke Health and Research Initiative (SHRI). The team should include a neurologist with experience in stroke medicine, a neuro-radiologist with experience in neuroimaging and interventional radiology, a neuro-intensivist with experience in neuro-critical care, and a neurosurgeon with experience in cerebrovascular surgery.

Different levels of care need to be provided starting with screening and triage [(brain attack triage, (BAT) ] units capable of resuscitation. All patients with acute cerebrovascular symptoms should be screened by basic haematological and other investigations (to rule out stroke mimics) followed by baseline neurological examination (utilizing the National Institutes of Health Stroke Scale [NIHSS], or the Glasgow Coma Scale [GCS]). Secondly, Brain Imaging and Treatment Decision (BIT) units need to be established, wherein appropriate neuroimaging is done and treatment decisions are made by the treating team. Comprehensive Cerebrovascular Care Units (CCCUs) are required to monitor the neurological status and provide adequate neuro-critical care while hybrid operation theatres (capable of both endovascular as well as open surgery) are prepared in advance. These units will provide continued neuro-critical care for patients requiring strict monitoring and intensive management.

Other requirements include Step down/recovery, Observation and Discharge units (SOD units) or post-surgical care and further management prior to discharge. These are summarized in [Figure 1] for better understanding of the protocols involved.
Figure 1: Stroke Health and Research Initiatives - Advanced stroke care model and future roadmap

Click here to view


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow