Guidelines for Cerebrovascular Accident

Introduction

Cerebrovascular accident, also called stroke is a condition that occurs when blood stops from to parts of the brain due to damaged or blocked blood vessels. There are several guidelines and best practices for stroke all stakeholders involved in treatment, diagnosis and management of stroke patients. According to Berglund et al (2012), all patients diagnosed with stroke ought to be treated as time critical emergency meaning that those patients who fulfil the thresholds for reperfusion therapies need prioritization- ambulances should be dispatched first to these types of patients and should be able to deliver stroke patients to hospitals offering such therapies and also stroke unit care. The ambulances should also notify the hospital earlier of a stroke patient in need of reperfusion therapy (O'Brien et al 2012). This is a prehospital stroke care guideline.

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While at the hospital, patients suspected to have stroke or who have been pre-informed to stroke and who may be eligible for reperfusion therapy should be seen immediately-at arrival, by the stroke doctors and other experienced medical staff (Meretoja et al. 2012). Also, these patients need to undergo brain imaging as soon as possible. All other patients not candidates for reperfusion therapies should undergo CT or MRI urgent- they should be health facilities with this equipment and in a span of one hour (Brazzelli et al. 2009). Again, patients who require vascular thrombectomy should have vascular imaging between aortic arch and the cerebral vertex to identify presence of Vascular occlusion as a thrombectomy target and do an assessment of the proximal vascular access (Goyal et al. 2016). Another recommendation talks about all hospitals offering stroke care services need to practice standardized protocols in the management of fever, glucose levels and swallowing problems in cerebrovascular accident patients (Middleton et al. 2011).

References

Berglund, A., Svensson, L., Sjostrand, C., von Arbin, M., von Euler, M., Wahlgren, N., ... & Engqvist, A. (2012). Higher prehospital priority level of stroke improves thrombolysis

Brazzelli, M., Sandercock, P. A., Chappell, F. M., Celani, M. G., Righetti, E., Arestis, N., ... & Sandercock, P. A. (2009). Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms. Cochrane Database Syst Rev, 4.

Goyal, M., Menon, B. K., Van Zwam, W. H., Dippel, D. W., Mitchell, P. J., Demchuk, A. M., ... & Donnan, G. A. (2016). Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. The Lancet, 387(10029), 1723-1731.

Meretoja, A., Strbian, D., Mustanoja, S., Tatlisumak, T., Lindsberg, P. J., & Kaste, M. (2012). Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology, 79(4), 306-313.

Middleton, S., McElduff, P., Ward, J., Grimshaw, J. M., Dale, S., D'Este, C., ... & Evans, M. (2011). Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial. The Lancet, 378(9804), 1699-1706.

O'Brien, W., Crimmins, D., Donaldson, W., Risti, R., Clarke, T. A., Whyte, S., & Sturm, J. (2012). FASTER (Face, Arm, Speech, Time, Emergency Response): experience of Central Coast Stroke Services implementation of a pre-hospital notification system for expedient management of acute stroke. Journal of Clinical Neuroscience, 19(2), 241-245.

Frequency and time to stroke unit: the Hyper Acute STroke Alarm (HASTA) study. Stroke, 43(10), 2666-2670.