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|Year : 2017 | Volume
| 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 Publication||10-Mar-2017|
Dr. Shriram Varadharajan
Department of Radiodiagnosis (Neuroradiology), CMC Hospital, Ludhiana, Punjab
Source of Support: None, Conflict of Interest: None
|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
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|
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Conflicts of interest
There are no conflicts of interest.