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(Stroke. 2003;34:362.)
© 2003 American Heart Association, Inc.

Advances in Stroke 2002

Review of Critical Care and Emergency Approaches to Stroke

Daniel F. Hanley, MD

From the Division of Brain Injury Outcomes, Johns Hopkins Hospital, Baltimore, Md.

Correspondence to Daniel F. Hanley, MD, Division of Brain Injury Outcomes, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD. E-mail dhanley@jhmi.edu

Key Words: hemorrhage • ischemia • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The past year has brought steady progress in our understanding of the emergent treatment of stroke. Substantial clinical information has come from post hoc and hypothesis-generated analyses of prior trials, as well as population-based ischemic stroke experiences. The main focus of ischemic stroke investigations in the past year has been to realize the benefits apparent in the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA trial on much broader routine care. Clearly, this involves developing a professional consciousness regarding the precise requirements of emergency stroke management. In addition, human studies have explored therapeutic and pathophysiological mechanisms in the major form of untreated stroke, intracerebral hemorrhage (ICH). The present overview will focus on the evolving knowledge in these 2 areas as pertains to emergency and intensive care unit (ICU) management.

Emergency Care Ischemic Stroke

A population-based, state-wide assessment of diagnostic and treatment capabilities for the state of Illinois was performed by Ruland et al.¹ Although this survey demonstrated that 93% of Illinois residents lived in a county with at least one acute care facility using a rt-PA treatment protocol, almost 30% of hospitals did not have such a protocol, and many were lacking in specialized personnel and equipment for stroke diagnostic technology such as MRI, transcranial Doppler, and consultation from Neurology and Neurosurgery. This survey demonstrates that substantial barriers to stroke care continue to exist at the personnel, diagnostic technology, and programmatic level. It remains clear that a systematic approach to emergency care for stroke has the potential to improve these deficits greatly.

Two . . . [Full Text of this Article]

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