Table 1
Table 2
Stroke type |
Aim |
Investigation |
All |
Ischaemic vs. haemorrhagic |
CT ± CTA, or MRI ± MRA, scanning immediately on admission to hospital |
Vital measures |
Blood pressure, weight/body mass index |
|
Blood tests |
Lipids, glucose, HbA1c, coagulation, markers for vasculitis and connective tissue disorders |
|
Severe high BP |
For secondary causes of hypertension |
|
Ischaemic/TIA |
Large artery stroke |
Carotid ultrasound (extra-cranial) |
CT and CTA, or MRI and MRA |
||
Atrial fibrillation |
ECG |
|
Prolonged arrhythmia recording |
||
Embolic stroke |
Echocardiography, and bubble contrast transcranial Doppler if performed locally |
|
Intracerebral haemorrhage |
CTA or MRA; digital subtraction angiography if appropriate. Interval blood sensitive MRI |
|
Subarachnoid haemorrhage |
CT and CTA, lumbar puncture; digital subtraction angiography if appropriate. Delayed CTA or MRA |
Table 3
Stroke type |
Intervention |
All |
|
Ischaemic stroke/transient ischaemic attack |
|
Large-artery disease |
|
|
|
|
|
Cardio-embolic stroke |
|
|
|
Lacunar stroke |
|
Other determined aetiology |
|
Intracerebral haemorrhage |
|
Subarachnoid haemorrhage |
|
Note: Interventions may not be relevant or appropriate in all patients, related to adverse events, concurrent conditions (e.g. dependent dementia).
AF: atrial fibrillation; CEA: carotid endarterectomy; NASCET: North American Symptomatic Carotid Endarterectomy Trial; NOAC: non-vitamin K oral anticoagulant; PCSK9: proprotein convertase subtilisin/kexin type 9; PFO: patent foramen ovale
Table 4
Affected area |
Frequency |
Consequences |
Treatment |
Motor function |
50-85 % |
Impaired balance, transfer ability, walking and reduced upper extremity function |
Task specific repetition training seems most beneficial |
Cognition |
≈ 1/2 |
Memory problems, reduced attention, executive dysfunction, and spatial neglect. May affect the person’s ability to manage daily life. |
No clear evidence of beneficial interventions. So far, often-compensatory strategies seem to work best. |
Communication |
≈ 1/3 |
Aphasia, ranging from occasional word-finding difficulties to having no effective means of verbal communication |
Information to patient and family in the acute setting |
*Many persons with stroke have more than one impairment. In addition, anxiety and depression are common after stroke.
Table 5
Table 6
Strategic step |
Action points |
Exploratory versus confirmatory studies |
– state-of-the art, rigorous, methodology – transparency – data availability (e.g. deposition of protocols/data in public repositories) – avoidance of publication bias |
Preclinical confirmatory studies as an intermediate translational step |
|
Improve experimental modelling |
|
Change to a larger ‘team’ concept |
|
Improve efficacy of early stage clinical trials |
|
Note: Interventions may not be relevant or appropriate in all patients, related to adverse events, concurrent conditions (e.g. dependent dementia).
AF: atrial fibrillation; CEA: carotid endarterectomy; NASCET: North American Symptomatic Carotid Endarterectomy Trial; NOAC: non-vitamin K oral anticoagulant; PCSK9: proprotein convertase subtilisin/kexin type 9; PFO: patent foramen ovale
Figure 1
Website by Studio Mzlaki