February 6, 2019

Understanding Severe Stroke Recognition & Management

International Stroke Conference 2019

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.

Download Key Learnings

Summary of key learnings from Biogen’s ISC 2019 Symposium

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.

EMS Evaluation
EMS Evaluation

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.

Transfer of Patients
Transfer of Patients

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.

Transfer of Patients
Transfer of Patients

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.

Transfer of Patients
Transfer of Patients

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.