Stroke is a condition in which a blood vessel ruptures in the brain and leads to internal bleeding or blockage of blood supply to the brain.
This leads to oxygen and blood deficiency in the tissue of the brain and the absence of oxygen, brain cells start to die within minutes.
Management of Stroke
Symptoms of stroke are likely to happen in a person when the tissues of the brain get damaged.
Following are some of the symptoms:
- Vision problems
- Trouble walking
- Loss of balance
Management of stroke is important as it can prevent the person from other risk factors associated with it. The first step in stroke management is Emergency Medical Services which starts from the hospital and includes the Stroke System of Care. This step is to stabilize a person which consists of laboratory studies and imaging in a short period. The step is done to evaluate and assess the patient’s condition. If any critical condition arises, then it includes various tests like blood pressure control, intubation need, or any need for thrombolytic intervention.
Some of the major aims of the emergency management of strokes are:
- Prevent Progression and Cell Death
- Restore Cerebral Circulation
- Restore the patient’s pre-stroke function to its optimum levelReduce Neurological Deficits
- Support Vital Functions
Stroke Management Algorithms
EMS Services and Acute Hospitals often use various algorithms for managing stroke effectively and provide them better treatments. The Stroke Triage Algorithm is created by the American Heart Association which includes crews with an ambulance and with the best tools for the identification of stroke and for assessing patient’s condition. It also helps in determining the right hospital according to the treatment needs.
Patients with neurological symptoms should be immediately detected under brain imaging. Following are the symptoms for performing brain imaging:
- Depressed level of consciousness
- Anticoagulant treatment
- Severe headache
- Bleeding tendency
Brain imaging should be performed within 24 hours on the onset of symptoms in patients lacking the above indications.
Level 1 Clinical Guidelines Recommendations
- Non-enhanced CT of the brain will depict the required information about further decisions related to emergency management. Emergency brain imaging is recommended before the initiation of acute stroke treatment.
- A noninvasive intracranial vascular study is usually recommended in case of contemplation of endovascular therapy. According to the guidelines of professional medical societies, noninvasive vascular imaging should be done before intravenous r-tPA.
In Ischemic stroke, the clot is broken down either with a medication called Thrombolysis or through a mechanical method called Thrombectomy. Other conditions of the patients should be monitored like blood sugar level, oxygen level, and required treatments. Patients experiencing acute ischemic stroke should be treated without delay within 3-4.5 hours after the onset of the symptoms.
Patients are given Tissue Plasminogen Activator(tPA) is a type of medication that dissolves in the blood clots and is administered with the help of a catheter into the vein of the arm. This is the early step in the treatment of ischemic acute stroke.
Although, this medication should be used in a moderate amount and under careful considerations as it includes risk and complications like symptomatic intracranial hemorrhage occurring at a rate of 5.2%. Guidelines under this medication are that patients should receive intravenous tPA, even if they are undergoing endovascular treatments.
In this therapy, a blood clot is removed physically with the help of mechanical thrombectomy or a catheter drug-based method. This method has shown positive results according to the researchers. Certain Clot Retrieval Devices are used in Endovascular Treatments and includes:
- The Penumbra Thrombectomy System: In this, the clot is removed by aspiration from large intracranial vessels.
- The Mechanical Embolus Removal in Cerebral Ischemia Thrombectomy System: In this method, a loop is used to remove a clot via a small catheter.
- The Solitaire Flow Restoration Device and the Trevo Retriever Device: In this method, the clot is bypassed and restored flow and receives clot.
Level 1 Clinical Guidelines Recommendations
If patients meet the following criteria, they should receive endovascular therapy:
- The Pre-stroke mRS score is from 0 to 1.
- Age is 18 or above.
- NIHSS score 6 or above
- ASPECTS of 6 or above
- Initiation of treatment within 6 hours of symptom onset.
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