Danielle de Sa Boasquevisque, MD
Stroke is a leading cause of death and a major source of disability worldwide. A Brazilian study performed by Martins and colleagues found that the percentage of hospitals with stroke centers, Emergency Medical Services (EMS), telemedicine, and endovascular services increased significantly between 2008 and 2017, after implementing a task force on stroke by neurologists with the assistance of the Brazilian Ministry of Health. However, these hospitals, equipped with specialized stroke centers, were concentrated in dense urban areas, neglecting the impoverished areas.
Now, the Brazilian Stroke Network aims to expand this model already tested in the urban regions to other parts of the country. Using mobile health technology and telemedicine, it has successfully provided the patients direct access to senior neurologists, who can diagnose complex cases and recommend treatment, hence shortening door-to-needle time and achieving better functional outcomes after stroke. However, it is still too expensive to be implemented nationwide.
In Canada, stroke networks like the above-mentioned are already well-established in many provinces. After endovascular trials, they aim to establish equitable access to neurological evaluation for the rural population and least densely-populated areas, by means of referencing complex cases to comprehensive stroke centers and by the adoption of telemedicine. Additionally, efforts are underway to train multidisciplinary teams, including Emergency Medical Services (EMS), and to raise public awareness of stroke.
This is a great moment to explore the world of intravenous thrombolysis and endovascular clot retrieval, and to pursue investigation of novel techniques to rehabilitate patients after a stroke. We are in an exciting time for stroke neurology: We have vast amounts of clinical data available, and it is tempting to prescribe treatments based solely on evidence-based clinical trials. But ultimately, we must keep in mind that our approach must still be focused on the individual patient.
October 29 is an opportunity to reinforce that each stroke patient presents a unique challenge. We are part of a community composed of: scientists, government workers, EMS, acute stroke and rehabilitation teams, as well as family and friends involved in the system care.
We recognize that it is our primary commitment to these individuals to combine efforts to prevent stroke, and when that fails, to save brain tissue by “acting fast” in treatment and, subsequently, rehabilitating our patients.
Those efforts include, but are not restricted to, supporting campaigns for raising public awareness about the importance of this condition and its symptoms, as well as secondary prevention (e.g., quitting smoking). Funding for the expansion of primary and comprehensive stroke centers, as well as for research, should be prioritized by governmental and non-governmental authorities.
We must also stimulate each individual patient’s creativity to help them rediscover and adapt to their sociocultural environment, as well as recognize and treat neuropsychological symptoms and depression.
Despite our best efforts, many patients will face different levels of impairment in their lives, but we will be there to empathetically support their learning on how to circumvent these new limitations. This way, we can get them #UpAgainAfterStroke.
