Current Advances, Challenges, and Opportunities in Stroke Research, Management, and Care

Stroke – Global challenges, local solutions, Version 1.0

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DOI:

https://doi.org/10.34714/leopoldina_nal-live_0002_01000

Keywords:

Stroke, Ischaemic Stroke, Hemorrhage, Contrast CT imaging, Non-contrast cranial computed tomography (CT) imaging, angiography, perfusion, magnetic resonance imaging (MRI), thrombolysis, thrombectomy, reperfusion, Prevention, hypertension, hyperlipidemia

Abstract

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Stroke is the second leading cause of death (after heart disease) and a major cause of disability worldwide. Also called a brain attack, typical symptoms of stroke include sudden one-sided weakness and numbness in the face and arm as well as altered speech. Most strokes are ischaemic strokes where arterial blood flow to the brain is interrupted by an embolism or thrombosis. Strokes are less frequently caused by haemorrhage. Non-contrast cranial computed tomography (CT) imaging, the workhorse of acute stroke diagnosis, can reliably differentiate between ischaemic stroke and intracerebral haemorrhage. Contrast CT imaging – including angiography, perfusion and magnetic resonance imaging (MRI) – can be used to detect large vessel occlusions and to identify ischaemic brain tissue that can still be salvaged by reperfusion. Treatment of acute ischaemic stroke focuses on the rapid reperfusion of brain tissue by means of intravenous thrombolysis and endovascular thrombectomy to salvage the at-risk tissue surrounding the infarct core. Reperfusion therapy is followed by specialised multidisciplinary stroke unit care and rehabilitation, all of which increases the chance of survival and reduces long-term disability. The mainstay of acute haemorrhagic stroke treatment in hypertensive patients is a lowering of blood pressure to stop haematoma expansion. Selected patients benefit from haemostatic agents or surgical treatment. Prevention of recurrent strokes includes lifestyle modifications and therapeutic interventions to control hypertension, hyperlipidaemia, diabetes, and smoking. Specific interventions to prevent recurrent strokes depend on the underlying stroke aetiology. These include antithrombotic medication, anticoagulation for atrial fibrillation, carotid endarterectomy or stenting, and the closure of a patent foramen ovale in ischaemic stroke patients.

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Published

23.07.2021