According to the Internet Stroke Center each year, 15 million strokes occur around the world, with almost 800,000 in the United States. This makes it a leading cause of morbidity and mortality and also a massive contributor to national healthcare costs. While relatively frequent, stroke diagnosis and management can be difficult. In addition, identifying a person at risk and intervening early enough to reduce that risk can be a real challenge. Failures in diagnosis or management can seriously impact patients for many years.
Diagnosis May Be Difficult – Early Warning Signs Stroke
Strokes occur when there is an interruption of the blood supply to the brain, and this can happen in many ways. This can make the diagnosis challenging, especially during the early stages. Early diagnosis allows for early interventions, which translates to less brain damage. Strokes also vary in severity, ranging from relatively minor to rapidly fatal. Recognizing severity can help allocate resources appropriately.
- Simplified Guy’s Score (G-score) After Stroke
- Orpington (Modified Edinburgh) Prognostic Score After Stroke
- Bedside Score for Identification of Nonhemorrhagic Ischemic Stroke
- Modified NIH Stroke Scale
- The European Stroke Scale
- The Los Angeles Prehospital Stroke Screen (LAPSS)
- Siriraj Stroke Score
A Wide Spectrum of Patients May Be Affected
One fascinating aspect of stroke care is the range of conditions that may be associated with strokes. While many patients have known risk factors for cardiovascular disease, some unexpected people may have strokes including patients with:
- atrial fibrillation
- neonatal complications
- head trauma
- substance abuse
- carotid stenosis or thrombosis
- arterial dissection
- Risk Factors for Stroke in Childhood Cancer Survivors Treated with Cranial and Cervical Radiation Therapy
- Risk Factors for Ischemic Stroke in a Patient with Systemic Lupus Erythematosus SLE
- 2009 Birmingham Score for Predicting Risk of Stroke and Thromboembolism in a Patient with Atrial Fibrillation (CHA2DS2-VASc)
- Measurement of Internal Carotid Stenosis Using CC, ECST and NASCET Criteria
An Unpleasant Surprise After Surgery
An important type of stroke from a medicolegal aspect is perioperative stroke. An older person with risk factors for cardiovascular risk would be expected to be at risk. However, almost any kind of surgery has some risk of stroke, often causing a complication that is unexpected.
- Risk Factors for Perioperative Stroke
- Carotid Endarterectomy 8-Item Score (CEA-8) for Predicting Perioperative Stroke or Death in an Asymptomatic Patient
- Estimating the Risk of Cerebrovascular Accident (CVA) After Isolated Coronary Artery Bypass Graft (CABG) Surgery Using the ACC/AHA Risk Score
Stroke May Lead to Serious Complications
A person who has a significant stroke is at risk for many complications. Some are physical while others are psychological, including marked personality change. Advances are being made so that stroke patients can be treated up to 24 hours after onset of symptoms with devices and medications that can reduce blood clots and in turn can reduce paralysis, speech difficulties, and other stroke disabilities. Coupled with devices, and medication, medical analytics can also aid clinicians in evaluating risk of complications after a stroke.
- Fall Risk Index Score for Patients in Stroke Rehabilitation
- Risk Factors for Hospital Readmission Following a Stroke
- Score for Predicting the Risk of Pneumonia Following a Stroke
Stroke May Entail a Complex Rehabilitation
Once a person has started to recover there is usually a need for rehabilitation. This may take years and a slow recovery can be a painful experience for the family and loved ones.
- The Rankin Scale For Stroke Disability
- The Trunk Control Test for Motor Impairment After Stroke
- The Motricity Index for Motor Impairment After Stroke
- The Frenchay Activities Index for Stroke Patients
- Pediatric Stroke Outcome Measure (PSOM)
- Predictors for Recovery from Disability Following a Recurrent Ischemic Stroke
Recognizing and Reducing Stroke Risk
Considering the impact of a stroke, prevention becomes an important task. Quite a few adults have atrial fibrillation and take oral anticoagulation to reduce the risk of stroke. While usually effective it is also a burden for the elderly and source of serious bleeding. Diabetics and patients with transient ischemic attacks (TIA) are at increased risk for stroke but prevention can be difficult.
- Updated Risk Profile for Stroke Risk Within 10 Years Based on the Framingham Study
- Risk of Stroke in a Patient with Type 2 Diabetes Mellitus in the UKPDS
- Essen Stroke Risk Score (ESRS) for Recurrent Stroke
- Prognostic Score for Predicting Major Stroke or Death in a Patient with a Transient Ischemia or Minor Stroke
- ABCD Score for Predicting the Risk of Stroke After a Transient Ischemic Attack (TIA)
- The ABCD2 Score for Evaluating a Patient’s Short Term Risk of Stroke Following a Transient Ischemic Attack (TIA)
- Anticoagulation Therapy in Non-Rheumatic Atrial Fibrillation
Take-Home Messages – Early Warning Signs Stroke
Stroke is an important healthcare problem around the world. Because of its potential complexity ready access to specialists is desirable but not feasible for many reasons. Telemedicine can help reach underserved areas, while medical algorithms can enable non-specialists to handle urgent problems.