Stroke; a journal of cerebral circulation
-
In the last 10 years, stroke has become a medical emergency. Subsequently, early recognition of stroke symptoms and rapid activation of the medical system are essential. We sought to investigate what witnesses or victims of an acute stroke syndrome recognize and report in the actual situation. ⋯ This is one of the first studies to investigate emergency calls in acute stroke. We found that motor deficits and speech problems were the most dramatic symptoms that led to activation of the EMS. Other symptoms were less frequently reported, or atypical descriptions were given. Educational efforts are needed to improve recognition of atypical stroke symptoms by stroke victims and EMS professionals.
-
Although the National Institutes of Neurological Disorders and Stroke (NINDS) has established time targets for the evaluation of acute stroke patients, little is known about how often these targets are met in the community. To track compliance with NINDS guidelines, Cuyahoga County Operation Stroke implemented a countywide data collection process that provides comparative reporting of hospital performance. ⋯ A countywide data collection system for acute stroke evaluation is feasible. In the Cleveland metropolitan area, time to physician contact is close to the recommended NINDS target. Time to CT and time to imaging results are substantially longer than recommended. However, there was wide variation between hospitals. The association between time to arrival, speed of evaluation, and administration of intravenous tissue plasminogen activator suggests that community physicians selectively accelerate the evaluation and management of potential thrombolysis candidates.
-
While emotional outcome is a critical factor influencing early evolution and late prognosis after stroke, few relevant studies have been performed on this subject. However, mood changes, modified judgment, and emotional reactions may also dramatically alter recruitment into clinical trials; for instance, up to one third of patients with acute stroke may have altered time perception, inappropriate self-evaluation of their condition, and attentional or memory dysfunction, with a subsequent increase in referral-to-hospital delays. In addition, the value of the "informed" consenting process may be questionable in the setting of urgent randomization into an acute stroke clinical trial. ⋯ It is especially disabling and frustrating in that it typically involves patients with total or near-total neurological recovery, who should have been able to go back to their previous activities but who become severely disabled because of early and persisting exhaustion. Preliminary neuropsychological and MR and PET imaging studies suggest that disruption of subtle mechanisms underlying attention, in the absence of significant cognitive and mood alterations, may be responsible. Research projects are now being launched to better delineate poststroke fatigue and its management.