Guidelines for Management of Ischaemic Stroke 2008 - ESO

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ESO-Guidelines for Management of Ischaemic Stroke 2008 Introduction Stroke is one of the leading causes of morbidity and mortality worldwide [4]. Large differences in incidence, prevalence and mortality have been noted between Eastern and Western Europe. This has been attributed to differences in risk factors, with higher levels of hypertension and other risk factors resulting in more severe stroke in Eastern Europe [5]. Notable regional variations have also been found within Western Europe. Stroke is the most important cause of morbidity and long term disability in Europe, and demographic changes will result in an increase in both incidence and prevalence. It is also the second most common cause of dementia, the most frequent cause of epilepsy in the elderly, and a frequent cause of depression [6, 7]. Many guidelines and recommendations for stroke management or specific aspects of stroke care have been published during the last decade [2, 8-18]. Most recently, the updated Helsingborg Declaration focused on standards of stroke care and research needs in Europe [19]. In the future, the global harmonization of stroke guidelines will be the focus of the World Stroke organisation, supported by the ESO and other national and regional stroke societies. - 6 -
ESO-Guidelines for Management of Ischaemic Stroke 2008 Public awareness and Education Recommendations Educational programmes to increase awareness of stroke at the population level are recommended (Class II, Level B) Educational programmes to increase stroke awareness among professionals (paramedics/emergency physicians) are recommended (Class II, Level B) The “time is brain” concept means that treatment of stroke should be considered as an emergency. Thus, avoiding delay should be the major aim in the prehospital phase of acute stroke care. This has far-reaching implications in terms of recognition of signs and symptoms of stroke by the patient or by relatives or bystanders, the nature of first medical contact, and the means of transportation to hospital. Delays during acute stroke management have been identified at different levels [20]: • at the population level, due to failure to recognize the symptoms of stroke and contact emergency services • at the level of the emergency services and emergency physicians, due to a failure to prioritize transport of stroke patients • at the hospital level, due to delays in neuroimaging and inefficient in-hospital care. A large amount of time is lost outside the hospital [21]: for stroke patients at a Portuguese university hospital this accounted for 82% of the delay in treatment [22]. Studies that identify demographic, social, cultural, behavioural and clinical factors associated with longer prehospital time may provide targets for educational campaigns [23, 24]. The interval from symptom onset to first call for medical help is the predominant part of prehospital delay [25-28]. Major reasons for delayed contact include lack of - 7 -
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Guidelines for Management of Ischaemic Stroke 2008 - ESO

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