scholarly journals Stroke Pentagon: Stroke Management Approach in Resource Poor Settings

2020 ◽  
Vol 13 (1) ◽  
pp. 57
Author(s):  
Chukwuemeka O. EZE
Keyword(s):  
Developing Countries ◽  
Vascular Occlusion ◽  
Stroke Care ◽  
Sudden Onset ◽  
Management Approach ◽  
Stroke Management ◽  
Focal Neurological Deficit ◽  
Case Presentation ◽  
Stroke Research ◽  
Cerebral Vascular Occlusion

Stroke is a neurological condition that is characterized by sudden onset focal neurological deficit due to spontaneous cerebral vascular occlusion or rupture. It is a neurological emergency and its prevalence is very high, especially in developing countries where it assumes an epidemic proportion. It is globally the second most common cause of death after ischaemic heart disease. The poor indices in developing countries are multifactorial and related to late case presentation, ignorance, poverty, and unavailability of comprehensive and well-coordinated stroke care. There is a need to identify the available and cheap stroke management steps in the developing countries and strengthen the system to maximize the benefits in reduction of the morbidity and mortality of stroke. It is against this background that we identified Stroke prevention, acute stroke management, Stroke rehabilitation, Stroke research, and Stroke support as five pillars (stroke pentagon) in stroke management in developing countries. There is a need to sensitize the stakeholders in stroke management as highlighted in the stroke pentagon to assume more responsibility. Moreover, there is the need to have a more coordinated and concerted stroke management approach which will involve all the identified five pillars to ensure improved stroke indices in the developing countries.

scholarly journals Young Male With Recurrent Headache: A Case Report

2020 ◽  
Author(s):  
Yu-Ta Chien ◽  
Shang-Yu Feng
Keyword(s):  
Emergency Department ◽  
Young Male ◽  
Sudden Onset ◽  
Secondary Headache ◽  
Neck Stiffness ◽  
Focal Neurological Deficit ◽  
Case Presentation ◽  
Computed Tomographic ◽  
Acute Meningitis ◽  
Headache Therapy

Abstract Background Headache, one of the most common symptoms presenting to the emergency department, is usually benign but sometimes fatal. Identifying high-risk headache syndromes and providing appropriate headache therapy remain the first priority for emergency physicians. Common “Red flags” includes sudden onset, focal neurological deficit, fever, neck stiffness and so on. We categorize headache into primary (such as tension, cluster headache and migraine) and secondary (subarachnoid hemorrhage, acute meningitis, intracranial hemorrhage, etc) while ruling out secondary headache is the first step in management. Case presentation We report a case of nasopharyngeal carcinoma(NPC) with defect at left side of nasopharynx and sphenoid sinus causing diffuse pneumocephalus. The 35-year-old male presented to the emergency department for sudden-onset headache with unusual associated symptom: rhinorrhea. Computed tomographic (CT) examination revealed a diffuse pneumocephalus, which did not present in magnetic resonance imaging of brain one month ago. The treatment was mainly conservative and the recovery was smooth.Conclusions Unusual symptoms like rhinorrhea and otorrhea should not be ignored, they might be the only clues to the diagnosis of pneumocephalus. Most of the pneumocephalus related to NPC occurred after recent radiotherapy. However, this patient finished radiotherapy on 2012/5. Thus, metastatic skull bony erosion with associated pneumocephalus might be taken into consideration.

scholarly journals EXPRESS: COVID-19 AND STROKE – UNDERSTANDING THE RELATIONSHIP AND ADAPTING SERVICES. A GLOBAL WORLD STROKE ORGANISATION PERSPECTIVE

2021 ◽  
pp. 174749302110064
Author(s):  
Hugh S Markus ◽  
Sheila Cristina Ouriques Martins
Keyword(s):  
Large Scale ◽  
Stroke Care ◽  
Long Term Effects ◽  
Vessel Occlusion ◽  
Stroke Incidence ◽  
Stroke Research ◽  
Incidence And Mortality ◽  
Research Initiatives ◽  
Global World

A year ago the World Stroke Organisation (WSO) highlighted the enormous global impact of the COVID-19 pandemic on stroke care. In this review we consider a year later where we are now, what the future holds, and what the long term effects of the pandemic will be on stroke. Stroke occurs in about 1.4% of patients hospitalised with COVID-19 infection, who show an excess of large vessel occlusion and increased mortality. Despite this association, stroke presentations fell dramatically during the pandemic, although emerging data suggests that total stroke mortality may have risen with increased stroke deaths at home and in care homes. Strategies and guidelines have been developed to adapt stroke services worldwide, and protect healthcare workers. Adaptations include increasing use of telemedicine for all aspects of stroke care. The pandemic is exacerbating already marked global inequalities in stroke incidence and mortality. Lastly the pandemic has had a major impact on stroke research and funding, although it has also emphasised the importnace of large scale collaborative research initiatives.

scholarly journals Acute motor-sensory axonal polyneuropathy variant of Guillain–Barre syndrome complicating the recovery phase of coronavirus disease 2019 infection: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ahmed Maseh Haidary ◽  
Sarah Noor ◽  
Esmatullah Hamed ◽  
Tawab Baryali ◽  
Soma Rahmani ◽  
...  
Keyword(s):  
Recovery Phase ◽  
Sudden Onset ◽  
Therapeutic Interventions ◽  
Guillain Barre Syndrome ◽  
The Novel ◽  
Case Presentation ◽  
Progressive Muscle Weakness ◽  
Guillain Barré Syndrome ◽  
Novel Coronavirus ◽  
Guillain Barré

Abstract Introduction The novel coronavirus, since its first identification in China, in December 2019, has shown remarkable heterogeneity in its clinical behavior. It has affected humans on every continent. Clinically, it has affected every organ system. The outcome has also been variable, with most of the older patients showing grave outcomes as compared with the younger individuals. Here we present a rare and severe variant of Guillain–Barre syndrome that complicated the disease in recovery phase. Case presentation A 60-year-old Afghan man, who had been recovering from symptoms related to novel coronavirus associated disease, presented with sudden onset of progressive muscle weakness and oxygen desaturation. Electrophysiological workup confirmed the diagnosis of Guillain–Barre syndrome, and early institution of intravenous immunoglobulin resulted in complete resolution. Conclusion Guillain–Barre syndrome has recently been reported in many patients diagnosed with novel coronavirus associated disease. While clinical suspicion is mandatory to guide towards an effective diagnostic workup, early diagnosis of this complication and timely institution of therapeutic interventions are indispensable and lifesaving.

scholarly journals Disabling stroke in persons already with a disability

Neurology ◽  
2020 ◽  
Vol 94 (7) ◽  
pp. 306-310 ◽  
Author(s):  
Michael J. Young ◽  
Robert W. Regenhardt ◽  
Thabele M. Leslie-Mazwi ◽  
Michael Ashley Stein
Keyword(s):  
Clinical Practice ◽  
Health Outcomes ◽  
Acute Stroke ◽  
Care Delivery ◽  
Stroke Care ◽  
Clinical Practices ◽  
Acute Stroke Care ◽  
Persons With Disabilities ◽  
Stroke Research ◽  
Scant Attention

Stroke is the second leading cause of death worldwide and a leading cause of adult disability worldwide. More than a third of individuals presenting with strokes are estimated to have a preexisting disability. Despite unprecedented advances in stroke research and clinical practice over the past decade, approaches to acute stroke care for persons with preexisting disability have received scant attention. Current standards of research and clinical practice are influenced by an underexplored range of biases that may hinder acute stroke care for persons with disability. These trends may exacerbate unequal health outcomes by rendering novel stroke therapies inaccessible to many persons with disabilities. Here, we explore the underpinnings and implications of biases involving persons with disability in stroke research and practice. Recent insights from bioethics, disability rights, and health law are explained and critically evaluated in the context of prevailing research and clinical practices. Allowing disability to drive decisions to withhold acute stroke interventions may perpetuate disparate health outcomes and undermine ethically resilient stroke care. Advocacy for inclusion of persons with disability in future stroke trials can improve equity in stroke care delivery.

scholarly journals Ileoileal knotting: a rare cause of intestinal obstruction: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yusuf Mohammed ◽  
Kirubel Tesfaye
Keyword(s):  
Abdominal Pain ◽  
Intestinal Obstruction ◽  
Sudden Onset ◽  
Rapid Progression ◽  
Case Presentation ◽  
Postoperative Course ◽  
Child Bearing ◽  
Mechanical Intestinal Obstruction ◽  
Tentative Diagnosis ◽  
Very High

Abstract Background Ileoileal knotting is one of the rarest causes of intestinal obstruction. The pathology involves knotting of the ileum around itself, leading to mechanical intestinal obstruction that can rapidly evolve to gangrene. Case presentation Here we will discuss the case of an 18-year-old Oromo girl who presented with sudden onset of severe abdominal pain and signs of generalized peritonitis.Ultrasound examination showed massive peritoneal and cul-de-sac fluid. Explorative laparotomy was done, with a tentative diagnosis of ruptured ovarian cyst. Intraoperative finding was a gangrenous ileoileal knot. The gangrenous segment was resected and ileotransverse anastomosis done. Postoperative course was uneventful, and the patient was discharged improved on the sixth postoperative day. Conclusion We present this case to highlight the diagnostic difficulty that one can face in females of child-bearing age and to create awareness of this rare cause of intestinal obstruction, as morbidity and mortality are very high because of rapid progression to gangrene.

scholarly journals Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

2018 ◽  
Vol 13 (9) ◽  
pp. 949-984 ◽  
Author(s):  
JM Boulanger ◽  
MP Lindsay ◽  
G Gubitz ◽  
EE Smith ◽  
G Stotts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Best Practice ◽  
Stroke Care ◽  
Stroke Management ◽  
Practice Recommendations ◽  
Prehospital Emergency ◽  
Ischemic Attack

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

scholarly journals Stroke in India: Bio-socioeconomic determinants

2016 ◽  
Vol 04 (02) ◽  
pp. 071-076 ◽  
Author(s):  
Sweta Singla ◽  
Rajiv Singla
Keyword(s):  
Culturally Diverse ◽  
Health Resources ◽  
Stroke Care ◽  
Disability Adjusted Life Years ◽  
Stroke Management ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Diverse Environment ◽  
Causes Of Mortality ◽  
Catastrophic Disease

AbstractWorldwide, stroke is one of the leading causes of mortality. Further, it leads to significant morbidity in the form of residual deficits and disability-adjusted life years. India with its culturally diverse environment and economically developing status presents unique challenges in providing stroke care. Various myths, misconceptions, poor knowledge about stroke, and poor availability of health resources afflict the nation and present barriers in stroke management. A multipronged approach to bring various disciplines together with the help of newer technologies such as smartphones and its applications need to be evolved to fight this catastrophic disease.

Focal Neurological Deficit with Sudden Onset as the First Manifestation of Sarcoidosis: A Case Report with MRI Follow-Up

1991 ◽  
Vol 31 (6) ◽  
pp. 376-379 ◽  
Author(s):  
A. Michotte ◽  
P. Dequenne ◽  
D. Jacobovitz ◽  
J. Hildebrand
Keyword(s):  
Case Report ◽  
Neurological Deficit ◽  
Sudden Onset ◽  
Focal Neurological Deficit

scholarly journals The Two Pathophysiologies of Focal Brain Ischemia: Implications for Translational Stroke Research

2012 ◽  
Vol 32 (7) ◽  
pp. 1310-1316 ◽  
Author(s):  
Konstantin-Alexander Hossmann
Keyword(s):  
Vascular Occlusion ◽  
Maximum Size ◽  
Focal Ischemia ◽  
Therapeutic Window ◽  
Stroke Research ◽  
Naturally Occurring ◽  
Free Interval ◽  
Postischemic Recirculation ◽  
Primary Core ◽  
Focal Brain Ischemia

Brain injury after focal ischemia evolves along two basically different pathophysiologies, depending on the severity of the primary flow reduction and the dynamics of postischemic recirculation. In permanent and gradually reversed focal ischemia as after thromboembolic occlusion, primary core injury is irreversible but the expansion of the core into the penumbra can be alleviated by hemodynamic and molecular interventions. Such alleviation can only be achieved within 3 hours after the onset of ischemia because untreated core injury expands to near maximum size during this interval. In promptly reversed transient ischemia as after mechanical vascular occlusion, primary core injury may recover but a secondary delayed injury evolves after a free interval of as long as 6 to 12 hours. This injury can be alleviated throughout the free interval but the longer window is without clinical relevance because transient mechanical vascular occlusion is not a model of naturally occurring stroke. As this difference is widely ignored in stroke research, most clinical trials have been designed with a far too long therapeutic window, which explains their failure. Transient mechanical vascular occlusion models should, therefore, be eliminated from the repertoire of preclinical stroke research.

Abstract T MP75: Facilities Available in Chinese Hospitals From China Stroke Research Network

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Chunjuan Wang ◽  
Zixiao Li ◽  
Yilong Wang ◽  
Yong Jiang ◽  
Xingquan Zhao ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Mainland China ◽  
Stroke Care ◽  
Research Network ◽  
Level Of Care ◽  
Minimum Level ◽  
Stroke Patients ◽  
Stroke Research ◽  
Primary Stroke Center ◽  
Stroke Center

Background and Purpose: Stroke is the first leading cause of death in China and millions of patients were admitted to various levels of hospitals each year. However, it is unknown how many of these hospitals are able to provide an appropriate level of care for stroke patients since the certification program of comprehensive stroke center (CSC) and primary stroke center (PSC) has not been initiated in China. Method: In 2012, we selected all 554 hospitals that joined into the China Stroke Research Network (CSRN) to start a survey. These hospitals were from 31 provinces or municipalities, covered nearly the entire Mainland China. A six-page questionnaire was sent to each of them to obtain the stroke facility information. We used the same criteria and definitions for CSC, PSC, and minimum level for any hospital ward (AHW) admitting stroke patients with that of the European Stroke Facilities Survey. Results: For all the hospitals in CSRN, 521 (94.0%) returned the questionnaire, 20 (3.8%) met criteria for CSC, 179 (34.4%) for PSC, 64 (12.3%) for AHW, and 258 (49.5%) met none of them and provided a lower level of care. Hospitals meeting criteria for CSC, PSC, AHW, and none of them admitted 70 052 (8.8%), 334 834 (42.2%), 88 364 (11.1%), and 299 806 (37.8%) patients in the whole of last year. There was no 24-hour availability for brain CT scan in 4.3% of hospitals not meeting criteria for AHW, while neither stroke care map nor stroke pathway for patients admission in 81.0% of them. Conclusions: Less than two fifths of Chinese hospitals admitting acute stroke patients have optimal facilities, and nearly half even the minimum level is not available. Our study suggests that only one half acute stroke patients are treated in appropriate centers in China, facilities for hospitals admitting stroke patients should be enhanced and certification project of CSCs and PSCs may be a feasible choice.

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