Dr. Amer Jafar writes:

Stroke can be a devastating disease as it might lead to death in third of the patients and disability in another third. Stroke causes over 4.3 million deaths world-wide annually. The focus on preventing stroke is important in any health care strategy. However; it remains a challenge to meet the standard level of care which is expected for acutely ill patients with ischaemic or haemorrhagic stroke. The recent Royal College of Physicians/London stroke audit¹ and the reports in the media yesterday² regarding stroke care are examples of the variation in the level of care for stroke patients in different regions of the country and even in between different hospitals, trusts or health boards in one area.

The basic standard of stroke care provision includes medical intervention within the first few hours of presentation to the acute medical units in the hospital which should include arranging a CT brain examination within the time window of 0-4.5 hours. Thrombolysing ischaemic stroke patients is vital within this time window. All the recent evidences in medical literature support the notion that the outcome of thrombolysing stroke patients is better than the outcome in otherwise routine conventional medical intervention.

The speed of transferring stroke patients from the general medical assessment units to a specialised stroke unit is another important factor in providing a good standard of care in stroke medicine.

There are different factors which can lead to the variation between different regions in the country with regard of the stroke care.

1. Stroke care can be expensive and not every hospital is expected to provide an immediate access to CT scanning or accessing immediately the stroke units for admitting patients. Some hospitals are lacking such units in the first place. This is in fact one of the major factor that can lead to the big variation between developing and developed countries regarding stroke care on the global level.
2. The issue of leadership and management is important in stroke care. It is a multidisciplinary care which depends on team work. Leaders are expected to practice to the high standard in the field of health in general and in stroke care in particular.
3. Providing an acceptable staffing level of skilful medical and other allied health professionals to stroke units is another important factor in improving the stroke care in any region.

1. http://www.rcplondon.ac.uk/press-releases/stroke-care-audit-results

1. http://www.independent.co.uk/news/uk/politics/variations-in-nhs-stroke-care-shock-mps-2375531.html

In the daily practice of Stroke physicians, there is always the concern about how accurate is the diagnosis and whether the physicians are going to end up thrombolysing non-stroke patients at the end.

Edlow and Salim wrote in the Lancet Neurology issue of June 2011 an interesting article about the atypical presentations of acute cerebravascualr syndromes.

They suggested three strategies which could help to reduce misdiagnosis of stroke.

First, clinicians should suspect stroke in any patient with abrupt onset of neurological symptoms. Second, clinicians should be aware that some patients will initially present with various uncommon and atypical stroke symptoms. Third, a complete and systematic neurological examination should be routinely done in patients presenting with acute neurological symptoms.

The latest issue of the British Medical Journal (BMJ) published a clinical review about the recent developments in the field of Transient Ischaemic Attack and Ischaemic Stroke (BMJ 2011; 342:d1938). The authors from Glasgow/Scotland raised few research questions at the end of their review. They tried to address the daily practice difficulties related to TIA and stroke care as well.