Die intrazerebrale Hirnblutung: Akutes Ereignis und chronische Erkrankung

2021 ◽  
Vol 78 (6) ◽  
pp. 320-327
Author(s):  
Martina Göldlin ◽  
Piotr Radojewski ◽  
Bernhard Siepen ◽  
Madlaine Müller ◽  
Roland Wiest ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Chronische Erkrankung ◽  
Care Bundle ◽  
Antithrombotische Therapie ◽  
Interdisziplinäre Behandlung ◽  
Stroke Center

Zusammenfassung. Die intrazerebrale Hirnblutung ist für ca. 10–15% aller Hirnschläge verantwortlich und betrifft in der Schweiz ca. 1’500–2’000 Patienten pro Jahr. Bei der Akutbehandlung ist eine interdisziplinäre Behandlung durch spezialisierte Experten in einer zertifizierten Stroke Unit oder einem Stroke Center von entscheidender Bedeutung. Ein simples ABC-care bundle (Antikoagulation revertieren, Blutdruck kontrollieren, Neurochirurgen informieren) kann das Outcome signifikant verbessern. Trotz einer hohen Mortalität sind ca. ein Drittel aller Patienten nach einer Hirnblutung funktionell unabhängig und der weitverbreitete Pessimismus ist unangebracht. Über 80% aller Hirnblutungen werden durch verschiedene Formen cerebraler Mikroangiopathien verursacht und die Risiken für eine erneute Hirnblutung oder einen ischämischen Hirnschlag unterscheiden sich deutlich. Hirnblutungspatienten sind vaskuläre Hochrisikopatienten mit einer chronischen, cerebrovaskulären Erkrankung. Sie sollten langfristig und regelmässig von neurovaskulären Spezialisten behandelt werden, um wichtige Fragen (Blutdruckmanagement, antithrombotische Therapie/Antikoagulation, spezialisierte Neurorehabilitation zur Verbesserung insbesondere neurokognitiver Defizite, Therapie zusätzlicher Komplikationen, z. B. Epilepsie) individuell zu klären und die optimale Behandlung für die Patienten zu gewährleisten. Viele aktuelle Studien werden in den nächsten Jahren wichtige Ergebnisse liefern, um die Behandlung der Hirnblutung weiter zu verbessern.

scholarly journals COVID-19: Stroke Admissions, Emergency Department Visits, and Prevention Clinic Referrals

2020 ◽  
Vol 47 (5) ◽  
pp. 693-696 ◽  
Author(s):  
Maria Bres Bullrich ◽  
Sebastian Fridman ◽  
Jennifer L. Mandzia ◽  
Lauren M. Mai ◽  
Alexander Khaw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Stroke Prevention ◽  
Stroke Unit ◽  
Emergency Department Visits ◽  
Related Factors ◽  
Hospital Policies ◽  
The Government ◽  
Stroke Center ◽  
The Impact ◽  
Prevention Clinic

Abstract:We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London’s regional stroke center, serving a population of 1.8 million in Ontario, Canada. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.

Stroke Unit- / Stroke Center-Management

2021 ◽  
Vol 78 (6) ◽  
pp. 328-338
Author(s):  
Joachim Fladt ◽  
Stefan Engelter ◽  
Gian Marco De Marchis ◽  
Marios Psychogios ◽  
Philippe Lyrer ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Units ◽  
Stroke Center ◽  
Prävention Und Therapie

Zusammenfassung. In der Schweiz erleiden etwa 16’000 Menschen pro Jahr einen Hirnschlag. Für deren Behandlung stehen derzeit 23 Stroke Units und Stroke Center zur Verfügung. Die Akutbehandlung auf einer Stroke Unit folgt einem standardisierten, ganzheitlichen und interdisziplinären Ansatz, dessen Kernaufgaben die Prävention und Therapie von Akutkomplikationen, die Ursachenabklärung und Rezidivprophylaxe sowie die Frührehabilitation und Sozialplanung umfassen. Die Stroke Unit-Behandlung senkt die Mortalität und das Risiko bleibender Beeinträchtigungen nach einem Hirnschlag und ist neben der intravenösen Thrombolyse und der mechanischen Thrombektomie der Grundpfeiler der Hirnschlag-Akutbehandlung. Der folgende Artikel liefert einen detaillierten Überblick über die Kernaufgaben und aktuellen Behandlungsstandards des Stroke Unit-Managements.

scholarly journals European Stroke Organisation Recommendations to Establish a Stroke Unit and Stroke Center

Stroke ◽  
2013 ◽  
Vol 44 (3) ◽  
pp. 828-840 ◽  
Author(s):  
E. Bernd Ringelstein ◽  
Angel Chamorro ◽  
Markku Kaste ◽  
Peter Langhorne ◽  
Didier Leys ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Center

scholarly journals Consequences of COVID-19 pandemic lockdown on emergency and stroke care in a German tertiary stroke center

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Robin Jansen ◽  
John-Ih Lee ◽  
Bernd Turowski ◽  
Marius Kaschner ◽  
Julian Caspers ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Hot Spot ◽  
Stroke Care ◽  
Single Center ◽  
Stroke Patients ◽  
Number Of Patients ◽  
Single Center Study ◽  
The Mean ◽  
Stroke Center ◽  
Center Study

Abstract Background COVID-19 pandemic caused a decline in stroke care in several countries. The objective was to describe lockdown stroke care in a tertiary stroke center in Düsseldorf, Germany near Heinsberg, a German hot spot for COVID-19 in spring 2020. Methods In a retrospective, observational, single-center study, we compared all patients treated in our emergency department (ED), patients seen by a neurologist in the ED, ED patients suffering from ischemic and hemorrhagic strokes and transient ischemic attacks (TIAs) as well as stroke patients admitted to our stroke unit during lockdown in spring 2020 (16 March 2020–12 April 2020) to those cared for during the same period in 2019 and lockdown light in fall 2020 (2 November – 29 November 2020). Results In spring 2020 lockdown the mean number of patients admitted to our ED dropped by 37.4%, seen by a neurologist by 35.6%, ED stroke patients by 19.2% and number of patients admitted to our stroke unit by 10% compared to the same period in 2019. In fall lockdown light 2020 effects were comparable but less pronounced. Thrombolysis rate was stable during spring and fall lockdown, however, endovascular treatment (EVT) rate declined by 58% in spring lockdown and by 51% in fall lockdown compared to the period in 2019. Conclusions Our study indicates a profound reduction of overall ED patients, neurological ED patients and EVT during COVID-19 pandemic caused lockdowns. Planning for pandemic scenarios should include access to effective emergency therapies.

scholarly journals Quality indicators of a stroke unit in Curitiba (Paraná)

2021 ◽  
Author(s):  
Camila Lorenzini Tessaro ◽  
Gabriela Ávila Rodbard ◽  
Marianna Yamila Gomes Brassaroto ◽  
Nathália Mitsue Kishi ◽  
Ramon Eduardo Szymczak Conde ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Quality Indicators ◽  
Stroke Unit ◽  
Intravenous Thrombolysis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Stroke Center ◽  
Epidemiological Profile

Background: Stroke represents the second leading cause of death and disability in Latin America. Thus, there is a constant need to understand the profile of patients admitted for stroke, as well as to analyze the quality indicators of treatment centers. Objectives: The aim of this study was to analyze the quality indicators of a stroke center in a tertiary service and to determine the epidemiological profile of inpatients. Design and setting: Observational cross- sectional study. Stroke unit from a tertiary center. Methods: The individuals included in the study were those admitted with stroke or TIA in the stroke unit of the Hospital de Clínicas - UFPR from November 2020 to April 2021. The variables and quality indicators were collected through the application of questionnaires in two moments, on admission and hospital discharge. Results: Of the 132 patients included, 53.8% were men, with a mean age of 62.7 years (SD +/- 17.5). Ischemic stroke was the most common type of stroke, accounting for 77.3% of cases. The majority of patients (68.9%) did not receive specific intervention, while 31% underwent intravenous thrombolysis, with a median door-to-needle time of 35 minutes. In 80.4% of the individuals, thrombolysis started in less than 60 minutes. All patients underwent neuroimaging, 87.4% underwent carotid imaging and 77.9% were monitored with Holter. Dysphagia screening was applied in 58.3% of cases. Regarding secondary prevention, 48.1% received antiplatelet drugs and 25.2% received anticoagulants. Conclusions: Intravenous thrombolysis is not performed in most hospitalized patients, however, when performed, it presents an adequate door-to-needle time. Hospitalization in a stroke unit allows a complete etiological investigation and optimization of secondary prevention and rehabilitation.

scholarly journals First Automated Stroke Imaging Evaluation via Electronic Alberta Stroke Program Early CT Score in a Mobile Stroke Unit

2016 ◽  
Vol 42 (5-6) ◽  
pp. 332-338 ◽  
Author(s):  
Iris Quasar Grunwald ◽  
Andreas Ragoschke-Schumm ◽  
Michael Kettner ◽  
Lenka Schwindling ◽  
Safwan Roumia ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Stroke Management ◽  
Imaging Evaluation ◽  
Vessel Occlusion ◽  
Stroke Treatment ◽  
Stroke Imaging ◽  
Mobile Stroke Unit ◽  
Potential Benefits ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Recently, a mobile stroke unit (MSU) was shown to facilitate acute stroke treatment directly at the emergency site. The neuroradiological expertise of the MSU is improved by its ability to detect early ischemic damage via automatic electronic (e) evaluation of CT scans using a novel software program that calculates the electronic Alberta Stroke Program Early CT Score (e-ASPECTS). Methods: The feasibility of integrating e-ASPECTS into an ambulance was examined, and the clinical integration and utility of the software in 15 consecutive cases evaluated. Results: Implementation of e-ASPECTS onto the MSU and into the prehospital stroke management was feasible. The values of e-ASPECTS matched with the results of conventional neuroradiologic analysis by the MSU team. The potential benefits of e-ASPECTS were illustrated by three cases. In case 1, excluding early infarct signs supported the decision to directly perform prehospital thrombolysis. In case 2, in which stroke was caused by large-vessel occlusion, the high e-ASPECTS value supported the decision to initiate intra-arterial treatment and triage the patient to a comprehensive stroke center. In case 3, the e-ASPECTS value was 10, indicating the absence of early infarct signs despite pre-existing cerebral microangiopathy and macroangiopathy, a finding indicating the program's robustness against artefacts. Conclusions: This study on the integration of e-ASPECTS into the prehospital stroke management via a MSU showed for the first time that such integration is feasible, and aids both decision regarding the treatment option and the triage regarding the most appropriate target hospital.

scholarly journals A Computer-Based Stroke Education Orientation Program for Nurses on a Designated Stroke Unit: A Program Development, Quality Improvement Project

2017 ◽  
Author(s):  
Melanie Marco
Keyword(s):  
Stroke Unit ◽  
Stroke Patients ◽  
Orientation Program ◽  
Improvement Project ◽  
Program Manager ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Computer Based ◽  
Stroke Education ◽  
Stroke Center

<p>Evidence of improved outcomes for patients admitted to a dedicated stroke unit supports the need for specialized stroke education and protocols. The Joint Commission now requires all stroke patients be admitted to a PSC and receive care on a designated stroke unit. Care on the stroke unit is focused on preventing further debilitation, deterioration and reducing medical complications. Nurses working at a primary stroke center are required by TJC to have initial orientation stroke education and annual competency review to ensure stroke patients receive high quality, current care. The Joint Commission also requires core stroke team members receive at least eight hours of education annually, as determined by the stroke program manager. The stroke program manager determines composition of the stroke team in collaboration with hospital leadership and other stakeholders (Daniels, Johnson & Mackovjak, 2011). It is the responsibility of each primary stroke center to develop an education program for clinical staff.</p> <p>The purpose of this quality improvement project was to develop a computer-based stroke education orientation program for nurses on a recently designated stroke unit within a PSC facility.</p>

Abstract TP391: Transition to a Single Dedicated Stroke Unit Improves Patient Satisfaction

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Patty Noah ◽  
Chris Hackett ◽  
Melanie Henderson ◽  
Leslie Pope ◽  
Vicki Cohen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Stroke Unit ◽  
Stroke Units ◽  
Assessment Scores ◽  
Care Assessment ◽  
The Press ◽  
Before And After ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
One Year

Introduction: Dedicated inpatient stroke units have been shown to decrease mortality and improve clinical outcomes. There is scant data on patient satisfaction within dedicated stroke units or the perception of care reported by the patient. At a single comprehensive stroke center we recently consolidated two stroke units on different physical locations to a single dedicated stroke unit, located in close proximity to the neuro ICU. We assessed patient satisfaction before and after transitioning to a single dedicated stroke unit. Methods: We analyzed the Press Ganey survey overall satisfaction scores for one year preceding and one year following transition to a single dedicated stroke unit. The overall satisfaction score is rated on a likert scale from 0 - 100. We also analyzed subsection of the Press Ganey survey. An independent samples T-test statistical analysis was used to compare the data. Results: The unified stroke unit was opened on January 1, 2018. We evaluated 177 Press Ganey surveys in the year preceding the transition and 191 surveys in the year following the transition to a single dedicated stroke unit. The overall patient satisfaction was significantly higher in the year after transitioning to single dedicated stroke unit (mean 91.3, SD = 15.7) than in the year prior (mean 87.6, SD = 19.7), [ 95%CI 0.06 - 7.34], p = 0.05. Additionally, after moving the dedicated stroke unit patient care assessment scores in the stroke unit increased and variance decreased (mean 95.5, SD = 8.4) compared to the year prior (mean 85.1, SD = 25.4), although this difference was not statistically significant, p = 0.28. Conclusions: We found that transitioning to a single dedicated stroke unit significantly improved patient satisfaction scores and provided patients with more consistent care.

scholarly journals Integrated multidisciplinary assessment of cerebral stroke outcome after treatment in a comprehensive stroke unit

2019 ◽  
Vol 28 (2) ◽  
pp. 50-58
Author(s):  
Yu.V. FLomin ◽  
V.G. Gurianov ◽  
L.I. Sokolova
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Stroke Unit ◽  
Rating Scales ◽  
Berg Balance Scale ◽  
Patient Treatment ◽  
Cerebral Stroke ◽  
Stroke Outcome ◽  
Stroke Center ◽  
Integral Assessment

Objective – to explore the possibility of integral assessment of the stroke outcome and to develop a method of integral assessment of the stroke outcome after in-patient treatment on the level of impairment and and the level of activities of daily living, which were assessed using rating scales and indices.Materials and methods. The study was conducted at the Stroke Center (SC), Oberig’ multidisciplinary hospital division, which operates according to the principles of Comprehensive Stroke Unit. Patients with a cerebral stroke who were admitted to the SC in 2010–2018 were enrolled. The data of the participants were prospectively entered into a special database and included discharge assessments using 8 valid rating scales and indices. Cluster analysis methods (in particular Kohonen neural networks) were used to design the integral assessment. Statistical analysis of the values ​​of the rating scales and indices in the selected clusters was performed using the Kruskal–Wallis criterion, post hoc comparisons were made using the Dunn multiple comparison criterion.Results. 852 patients (42.5 % women and 57.5 % men, median age – 66.7 year) were enrolled. 81 % of patients were diagnosed with ischemic stroke, and 19 % had hemorrhagic stroke. According to the chosen method, it is necessary and sufficient to split the data into 4 clusters. All participants in the study according to their assessments at discharge using the set of selected measures could be assigned to one of 4 isolated clusters: K1 (n = 366), K2 (n = 93), K3 (n = 104) or K4 (n = 289). National Institutes of Health Stroke Scale, modified Rankin scale, Barthel Index, Berg Balance Scale та Functional Ambulation Classification were the most significant determinants of the patient cluster. For the 5 measures there have been significant differences (p < 0.001) in the four clusters. The condition of the patients in K4 cluster was the best (p < 0.05), whereas the patients in the K1 cluster were worse (p < 0.05), and the condition of the patients in the clusters K2 and K3 was much worse (p < 0.05) compared with the cluster K4.Conclusions. Based on the integrated assessments of neurological impairments and activities of daily living all of stroke patients could be assigned to one of four identified clusters. Detecting predictors of poor outcome after in-patient management may help to find ways to improve their prognosis.

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