Welcome, Introduction, and Objectives
Panel chair Greg Albers, MD, introduces the symposium’s topics, objectives, and expert panelists. He also introduces “The Case of Ms. S,” which describes the journey of a fictional patient with LHI who is followed throughout the presentation.
Key learnings from Biogen’s ISC 2019 Symposium
EMS Evaluations: Train personnel to rapidly evaluate and stabilize patients
Providing prompt feedback to the multidisciplinary stroke team on protocols and procedures may improve patient outcomes.
Goal: Train personnel to rapidly evaluate and stabilize patients1
- Assess airway, breathing, and circulation1
- Obtain medical history (eg, time of symptom onset)1
- Use prehospital assessment tools (eg, LAPSS,2 RACE,3 FAST-ED4)
- Communicate necessary information to receiving hospital in a timely manner1
FAST-ED, Field Assessment Stroke Triage for Emergency Destination; LAPSS, Los Angeles Prehospital Stroke Screen; RACE, Rapid Arterial Occlusion Evaluation.
1. Jauch et al. Stroke. 2013;44:870-947. 2. Kidwell et al. Stroke. 2000;31:71-76. 3. Pérez de la Ossa et al. Stroke. 2014;45:87-91. 4. Lima et al. Stroke. 2016;47:1997-2002.
Goal: Establish protocols to transfer patients to appropriate acute care facility5
- Establish transfer protocols on basis of
- Neuroimaging capabilities
- Availability of specialists and access to telestroke
- Stroke severity/time of symptom onset
5. Higashida et al. Stroke. 2013;44:2961-2984.
Goal: Assess clinical and neurological characteristics
- Conduct neurological exam to evaluate neurological deficit7
- Perform neuroimaging to assess lesion size/location and presence of LVO1
- NCCT can exclude intracranial hemorrhage and stroke mimics8
- CTP helps identify patients for reperfusion treatment8
- DW-MRI is sensitive and specific in identifying acute infarctions1
CTP, computed tomography perfusion; DW-MRI, diffusion-weighted magnetic resonance imaging; LHI, large hemispheric infarction; LVO, large vessel occlusion; NCCT, noncontrast computed tomography; NIHSS, National Institutes of Health Stroke Scale.
1. Jauch et al. Stroke. 2013;44:870-947. 6. Kimberly and Sheth. Neurol Clin Pract. 2011;76(7 suppl 2):S50-S56. 7. Powers et al. Stroke. 2018;49:e46-e110. 8. Birenbaum et al. West J Emerg Med. 2011;12:67-76.
Goal: Prevent progression from LVO to LHI
- Perform thrombectomy in appropriate patients within recommended timetables7
- Monitor clinical status (NIHSS,11 Glasgow coma scale,12 oculomotor exam13) to assess disease progression7
- Assess need for DHC to relieve high ICP14; this procedure may increase the likelihood of survival and offer positive patient outcomes15
DHC, decompressive hemicraniectomy; ICP, intracranial pressure; LHI, large hemispheric infarction; LVO, large vessel occlusion; NIHSS, National Institutes of Health Stroke Scale.
7. Powers et al. Stroke. 2018;49:e46-e110. 9. Torbey et al. Neurocrit Care. 2015;22:146-164. 10. Rahme et al. J Neurosurg. 2012;117:749-754. 11. Kasner. Lancet Neurol. 2006;5:603-612. 12. Weir et al. Q J Med. 2003;96:67-74. 13. Rowe. Brain Behav. 2017;7:e00771. 14. Wijdicks et al. Stroke. 2014;45:1222-1238. 15. Vahedi et al. Lancet Neurol. 2007;6:215-222.
Disclosure: All panelists received honoraria from Biogen for participation in this symposium.
Disclaimer: All of the information discussed today is for informational purposes only; does not constitute medical advice; and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment.