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STROKE CARE
Practical Aspects for General Physician
M. KURNIAWAN, MD
DEPT. NEUROLOGI FKUI/RSCM
OUTLINES
OUTLINES
WORLDWIDE IMPACT
Annually 15 million people, 5 million death, 5 million
permanently disable because of stroke
Every 2 seconds : someone in the world suffers a stroke
Every 6 seconds : someone dies of a stroke
Every 6 seconds : someones QOL will forever be changed
permanently disabled
The lifetime risk of stroke :
1 in 5 for women
1 in 6 for men
Economic burden of stroke : US$ 53,6 billion
Direct cost : US$ 33 billion
Indirect cost : US$ 20,6 billion per-year
Synapses
Lost
Myelinated
fibers Lost
Premature
Aging
1 second
32,000
230 million
200 m
8.7 hours
1 minute
1.9
million
14 billion
12 km
3.1 weeks
1 hour
120
million
830 billion
714 km
3.6 years
1.2 billion
8.3 trillion
7140 km
36 years
Time
Complete
TIME IS
BRAIN!
STROK
E
Time lost is
Brain lost
OUTLINES
WHAT IS STROKE ?
WHO, 1970
rapidly developing clinical signs of
focal (or global) disturbance of
cerebral function, lasting more than
24 hours or leading to death, with
no apparent cause other than that
of vascular origin
TYPES OF STROKE
ISCHEMIC STROKE - 80%
Embolic :
Blood clot forms
somewhere in the
body and travels to the brain
Thrombotic :
Clot forms on blood vessel
deposits
HEMORRHAGIC STROKE
(20%)
OUTLINES
Sensory symptoms
Sudden numbness/tingling of face, arm or leg, esp. on one side of body
OUTLINES
SCOPE OF STROKE
CARE
1. Primary Prevention
2. Early Detection
Screen for signs and symptoms Using screening tools
OUTLINES
MODIFIABLE RISK
FACTORS
PRIMARY STROKE
PREVENTION
Knowing and manage risk factors
Risk stratification for more advance screening
examination by specialist (e.g : Echocardiography,
Carotid Doppler, Transcranial Doppler/TCD)
OUTLINES
Total score:
3 Clear evidence of stroke
2 Strong evidence of stroke
1 Partial evidence of stroke
0 No evidence of stroke
Govindarajan et al. BMC Neurology
2011;11:14.
PREHOSPITAL STROKE
Recommended
CARE
Manage
ABCs
OUTLINES
Maintain ABC
Knowing neurologic signs & symptoms
Perform focused neurologic exams
Clinical exams in 10 minutes time !!!
If suspected stroke perform urgent Brain CT-Scan
This part must be done in Health Facility which has CT-Scan
Consult to neurologist for Reperfusion/Recanalization Therapy
and Acute Stroke Care
Intravenous thrombolysis
Intraarterial thrombolysis
Mechanical thrombectomy
NIH-RECOMMENDED ED
RESPONSE TIME
DTN 60 min : the golden hour for evaluating & treating acute stroke
10 min
15 min
T=0
Suspected Initial MD evaluation Stroke team
stroke patient (including patient
notified
arrives at
history, lab work
(including
stroke unit
initiation, & NIHSS) neurologic
expertise)
25 min
CT scan
initiated
45 min
CT & labs
interpreted
60 min
rt-PA
given if
patient
is eligible
INCLUSION CRITERIA
1.
2.
3.
4.
5.
6.
THROMBOLYSIS PATHWAY
Arrival to ED
A&PE assessment
EXCLUSION CRITERIA
1.
2.
3.
4.
DTN
60 min
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
IGD
(Triage)
Ruang
Rawat
Pasien
dicurigai
Stroke
CODE STROKE
RSCM/FKUI
DOKTER EMERGENSI
CURIGA STROKE AKUT <
4.5 jam)
ACTIVATE CODE
STROKE
Urgent
CT/MRI
Brain
Konsul / Refer
cito !
Neurologi
DPJP
NEUROLOGI
ELIGIBILITAS
TROMBOLISIS
Lihat Ceklis
START
TROMBOLISIS
TRANSFER KE
RUANGAN
(STROKE
2.GDS (stick)
3.Lab (bila perlu)
(Warfarin INR ; NOAC
APTT)
4. Order Urgent CT/MRI Brain
5. Nilai NIHSS
6.Pasang iv-line
7.Call Neurologist
DPJP Neurologi
OUTLINES
THANK YOU