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An analysis of time of presentation after stroke

Article Abstract:

Each year 150,000 adults in the United States die from stroke. Several hundred thousand more are disabled as a result of the hemorrhages or cerebrovascular accidents which occur within the skull, and deprive brain tissue of required circulation. Recently several methods of treatment have proved to be successful when given shortly after the onset of the stroke. This paper assesses the delay between the time a stroke begins and the time that the patient is first seen for medical treatment. While patients with heart attacks are normally brought for medical attention rapidly, probably because of chest pain, patients with stroke seek medical attention relatively late. Only 42 percent of the 457 patients included in this study were seen within 24 hours of the onset of the cerebrovascular event. An additional 25 percent of patients were seen within 48 hours after the onset of their stroke. To some degree the location of the hemorrhage was a factor in the time interval before the patient was seen by a physician. Patients with hemorrhages deep within the brain tissue (intracerebral) sought medical attention more rapidly than patients in whom the cerebrovascular accident occurred between the membranes covering the brain and the brain itself (subdurally). In summary, 58 percent of all patients with stroke were seen after a delay of more than 24 hours. This may be due to the fact that few people know the signs of a stroke (42 percent in a survey) and fewer (1 percent) know that it is a leading cause of death. Unless the importance of receiving rapid medical attention is understood by the general public, the morbidity and mortality of cerebrovascular accidents will not be reduced by the new and effective treatments which are available.

Case studies, Cerebrovascular disease, Cerebrovascular disorders, Brain diseases

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Prognosis and decision making in severe stroke

Article Abstract:

The aim of the study is to review the available evidence on prognosis in mechanically ventilated stroke patients and to provide an overall framework to optimize decision making for clinicians, patients, and families. It is concluded that prognosis can be assessed according to clinical presentation and patient characteristics, and that there is an urgent need to better understand the marked variation in the care of these patients and to reliably measure and improve the patient-centeredness of such decisions.

United States, Prognosis, Informed consent (Medical law), Informed consent

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