Stroke management in the modern settings
Authors: Moskovko S.P. , Kyrychenko O.V. 
Published: July 2021

Background. Each 6 seconds 1 person in the world dies of a stroke. The stages of stroke care are the following: case detection, emergency medical care, diagnosis, treatment in the hyperacute and acute period, early and subsequent rehabilitation. The main symptoms of stroke can be identified with the help of FAST system (face – facial asymmetry, arm – limb weakness, speech – blurred speech, time – time after the event).

Objective. To identify the main features of the management of stroke patients.

Materials and methods. Analysis of the guidelines and literature data.

Results and discussion. According to the recommendations of the American Heart Association for the emergency service, the time of processing of the call should be up to 90 seconds, the response time of the emergency service – 8 minutes, and the time spent at the place of care – up to 15 minutes. Upon admission to the hospital, the doctor of the stroke unit collects the anamnesis and takes a brief neurological examination, as well as determines the main physiological parameters. The nurse performs tests, the results of which come during thrombolysis. Then the patient undergoes a computed tomography, first aid is given and thrombolysis begins (still in the tomography apparatus). Time must be constantly documented. The median time should be 25 minutes. To organize the work of the stroke unit in the hyperacute and acute period of stroke it is necessary to create a local protocol – a document that lists the care procedures in a particular institution and describes the responsibility and coordination of individual units, time frames of each stage and basic medical services. It is also necessary to create a clinical roadmap for the patient, which includes a map of his moving, the content of procedures and their timer. Optimization of the stroke management is extremely important, as each 15 minutes of time saved leads to the 4 % reduction in mortality and to the 4 % increase in the likelihood of no adverse effects. In the first 3 hours it is especially important to monitor such parameters as body temperature, blood glucose, swallowing function (fever, sugar, swallowing – FESS) thoroughly. It is a significant problem, but for the most options of medical support the evidence base is insufficient, and therefore the doctor faces the choice to follow imperfect recommendations or to prescribe drugs according to the pathogenesis of cerebral ischemia. This choice has to be made in settings of severe time shortage, because the stroke kills 9,000 neurons every second. Stages of the ischemic cascade include ischemia, glutamate excitotoxicity, mitochondrial damage and dysfunction, oxidative and nitrosative stress, inflammation, and microcirculation disorders. Edaravone affects these stages, reducing the activity of oxygen radicals, the permeability of the blood-brain barrier, and the activity of secondary inflammation. This reduces the ischemic penumbra and the brain tissue necrosis area, which increases the likelihood of functional recovery. The study by M. Enomoto et al. (2019) showed that the use of edaravone and the endovascular reperfusion is a promising strategy for the treatment of ischemic stroke.

Conclusions. 1. To coordinate the work of the stroke unit in the hyperacute and acute period of stroke, it is necessary to create local protocols and the clinical roadmap. 2. During the first 3 hours it is especially important to monitor such parameters as body temperature, blood glucose, and swallowing function. 3. Edaravone affects the ischemic stroke, reducing the activity of oxygen radicals, the permeability of the blood-brain barrier, and the activity of secondary inflammation.