Guidelines for Management of Ischaemic Stroke 2008 - ESO

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ESO-Guidelines for Management of Ischaemic Stroke 2008 While only a minority of stroke patients present in an immediately life-threatening condition, many have significant physiological abnormalities or comorbidities. Symptoms and signs which may predict later complications such as space-occupying infarction, bleeding, or recurrent stroke, and medical conditions such as hypertensive crisis, co-existing myocardial infarction, aspiration pneumonia, or cardiac and renal failure, must be recognized early. Stroke severity should be assessed by trained staff using the National Institutes of Health Stroke Scale (NIHSS) [103]. Initial examination should include: • observation of breathing and pulmonary function • early signs of dysphagia, preferably with a validated assessment form [104] • evaluation of concomitant heart disease • assessment of blood pressure (BP) and heart rate • determination of arterial oxygen saturation using infrared pulse oximetry if available. Simultaneously, blood samples for clinical chemistry, glucose, coagulation and haematology studies should be drawn, and a venous line inserted. The examination should be supplemented by a medical history that includes risk factors for stroke and cardiac disease, medications, conditions that may predispose to bleeding complications, and markers for stroke mimics. A history of drug abuse, oral contraceptive use, infection, trauma or migraine may give important clues, particularly in young patients. - 16 -
ESO-Guidelines for Management of Ischaemic Stroke 2008 Stroke services and stroke units Recommendations It is recommended that all stroke patients should be treated in a stroke unit (Class I, Level A) It is recommended that healthcare systems ensure that acute stroke patients have access to high technology medical and surgical stroke care when required (Class III, Level B) The development of clinical networks, including telemedicine, is recommended to expand access to high technology specialist stroke care (Class II, Level B) Providing stroke services All acute stroke patients require specialist multidisciplinary care delivered in a stroke unit, and selected patients will require additional high technology interventions. Health services need to establish the infrastructure to deliver these interventions to all patients who require them: the only reason for excluding patients from stroke units is if their condition does not warrant active management. Recent consensus documents [11, 105] have defined the roles of primary and comprehensive stroke centres (Table 4). Primary stroke centres are defined as centres with the necessary staffing, infrastructure, expertise and programmes to provide appropriate diagnosis and treatment for most stroke patients. Some patients with rare disorders, complex stroke, or multi-organ disease may need more specialized care and resources that are not available in primary stroke centres. Comprehensive stroke centres are defined as centres that provide both appropriate diagnosis and treatment for most stroke patients, and also high technology medical and surgical care (new diagnostic and rehabilitation methods, specialized tests, automatic monitoring of multiple physiological parameters, interventional radiology, vascular surgery, neurosurgery). - 17 -
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Guidelines for Management of Ischaemic Stroke 2008 - ESO

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