Effective strategies for improving outcomes require efficient triage and interdisciplinary cooperation
When I commenced work as a junior neurologist, one of the first patients admitted under my care was a woman with a history of atrial fibrillation who presented acutely with a major stroke in her dominant hemisphere, causing aphasia and a dense right-sided hemiparesis. After examining the woman, I explained to her son — one of my colleagues — that the prognosis was poor; should his mother survive, she would probably be left with significant long term disability. He responded that he had just read a report in Nature about removing clots from blood vessels to reperfuse the brain during an acute stroke. The approach seemed rational, although it appeared to rest more in the realm of science fiction than something that would be of practical clinical use anytime soon.
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- 1. Cadilhac DA, Kilkenny MF, Levi CR, et al. Risk-adjusted hospital mortality rates for stroke: evidence from the Australian Stroke Clinical Registry (AuSCR). Med J Aust 2017; 206: 345-350.
- 2. Hankey GJ. Assessing the outcome of stroke in Australia. Med J Aust 2017; 206: 343-344.
- 3. Berkhemer OA, Fransen PS, Beumer D, et al; for the MR CLEAN investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11-20.
- 4. Campbell BC, Mitchell PJ, Kleinig TJ, et al; for the EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009-1018.
- 5. Flossmann E, Redgrave JN, Briley D, Rothwell PM. Reliability of clinical diagnosis of the symptomatic vascular territory in patients with recent transient ischaemic attack or minor stroke. Stroke 2008; 39: 409-419.
- 6. Park CH, Kou N, Ward NS. The contribution of lesion location to upper limb deficit after stroke. J Neurol Neurosurg Psychiatry 2016; 87: 1283-1286.
- 7. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 2014; 383: 245-254.
- 8. Hinman JD, Rost NS, Leung TW, et al. Principles of precision medicine in stroke. J Neurol Neurosurg Psychiatry 2017; 88: 54-61.
- 9. Lavine SD, Cockroft K, Hoh B, et al. Training guidelines for endovascular ischemic stroke intervention: an international multi-society consensus document. AJNR Am J Neuroradiol 2016; 37: E31-E34.
I gratefully acknowledge funding by a National Health and Medical Research Council of Australia Program Grant (#1037746).
No relevant disclosures.