Neurology And Stroke: Timing For Patient Referral

Stroke is a leading cause of death and long-term disability in the United States, affecting nearly 800,000 Americans annually. It occurs when there is an abrupt interruption of blood flow to the brain, resulting in the loss of neurological function and potential brain cell death. As stroke is a medical emergency, it is crucial to seek immediate treatment to improve the chances of recovery. This is where neurologists, specifically vascular neurologists, play a vital role. They are specialists who focus on diagnosing, treating, and managing stroke and its risk factors. Their expertise in understanding brain function, anatomy, and different types of strokes enables them to provide ongoing care and support to stroke survivors, helping them regain function and prevent recurrent strokes.

The importance of seeing a neurologist after a stroke

Strokes are a leading cause of death and disability worldwide. They occur when there is an abrupt interruption of constant blood flow to the brain, causing brain cells to die and resulting in loss of neurological function. While immediate medical attention is crucial to saving lives and enhancing recovery prospects, follow-up care with a neurologist is also essential for optimising long-term recovery.

Expertise in Acute Care and Long-Term Management

Neurologists are specialists in the diagnosis and treatment of nervous system disorders, including strokes. They have extensive knowledge of brain function, anatomy, and the various types of strokes, enabling them to provide expert care and support to stroke survivors. Their expertise is crucial in both acute care and long-term management, ensuring patients receive the best possible treatment to maximise their recovery.

Accurate Diagnosis and Personalised Treatment Plans

A neurologist will conduct a thorough assessment to understand the extent and impact of the stroke. This includes a neurological examination to evaluate cognitive functions, motor skills, and sensory perception, as well as imaging studies such as CT scans and MRI to visualise the affected areas of the brain. Based on this evaluation, they will devise a personalised treatment plan tailored to the patient's specific needs.

Medication and Rehabilitation

Neurologists prescribe medications to prevent further strokes, manage risk factors such as high blood pressure, cholesterol, and diabetes, and alleviate symptoms. They also recommend rehabilitation therapies, including physical, occupational, and speech therapy, to aid in recovery and improve function. These treatments aim to help stroke survivors regain as much function as possible and improve their overall quality of life.

Monitoring and Follow-up Care

Regular follow-up visits with a neurologist are essential for continuous monitoring of the patient's progress and adjusting treatments as needed. This ongoing care helps prevent recurrence by identifying and managing risk factors, addressing complications such as seizures or depression, and providing guidance and support throughout the rehabilitation process. Neurologists also play a crucial role in educating patients and their families about stroke recovery and prevention, offering advice on lifestyle changes to improve overall health and reduce the risk of future strokes.

Early Intervention for Optimal Outcomes

Early neurological assessment and intervention are critical for achieving the best outcomes. If a neurologist is not involved during the initial hospital stay, it is imperative to schedule an appointment as soon as possible after discharge to arrange a comprehensive evaluation and establish a follow-up care plan.

The role of vascular neurologists in stroke treatment

Vascular neurologists, also known as stroke doctors, are specialists who focus on the different types of strokes and stroke risk factors. They are experts in vascular issues involving the central nervous system. This includes stroke, brain haemorrhages, aneurysms, spinal cord haemorrhage, and other kinds of brain bleeds.

Vascular neurologists play a crucial role in stroke treatment and care. They can provide both emergency and ongoing care for stroke patients. In an emergency setting, vascular neurologists are part of the hospital team that quickly and accurately interprets diagnostic tests, such as CT scans and cerebral angiographies, to identify the type of stroke and determine the appropriate treatment. They also recommend treatment next steps and administer medications like tissue plasminogen activator (tPA) to treat ischemic strokes and help reverse damage.

During the hospital stay and beyond, vascular neurologists help patients manage any lasting effects of the stroke and work to reverse stroke risk factors. They evaluate a patient's brain and nervous system health using diagnostic imaging tests and specialised screening tests. They monitor symptoms, recommend additional treatments, and connect patients with relevant therapies or clinical trials. Vascular neurologists also coordinate care with other specialists and stroke team members to ensure integrated and comprehensive care for their patients.

In addition to stroke treatment, vascular neurologists can help prevent strokes by assessing and managing stroke risk factors. They can provide education and guidance on cerebrovascular health and disease prevention. They also screen for and treat conditions that increase the risk of serious brain and spinal cord conditions, such as head injuries, blood vessel abnormalities, and blood clotting disorders.

Vascular neurology is a subspecialty of neurology that requires additional training after completing a neurology residency. This subspecialty training focuses on the latest techniques in stroke care, including interventional treatments. By seeking care from a vascular neurologist, patients can benefit from their specialised knowledge and expertise in stroke treatment and prevention, reducing the risk of permanent damage, disability, and other complications.

Emergency stroke treatment

A stroke is an abrupt interruption of the constant blood flow to the brain, which causes a loss of neurological function. The interruption of blood flow can be caused by a blockage, leading to an ischemic stroke, or by bleeding in the brain, leading to a hemorrhagic stroke. Ischemic strokes constitute an estimated 87% of all stroke cases.

It is crucial that the blood flow and oxygen supply to the brain are restored as soon as possible. Brain cells can be damaged or die within minutes of the interruption, and they generally do not regenerate. Therefore, emergency treatment for stroke patients is vital.

If you are able to get to the hospital within a few hours of the beginning of your stroke symptoms, you have a better chance of recovery. Treatments are far more effective and safe when administered within the first few hours before permanent damage occurs. The only U.S. Food and Drug Administration (FDA)-approved medication for ischemic stroke is tissue plasminogen activator (tPA), which must be administered within a three-hour window from the onset of symptoms to be most effective. Unfortunately, only 3-5% of stroke patients reach the hospital in time to be considered for this treatment. tPA carries a risk of increased intracranial haemorrhage and is not used for hemorrhagic strokes.

In the first 24 hours after a stroke, treatment may include:

• Thrombolysis: medicine to get rid of blood clots in the brain.
• Thrombectomy: surgery to remove a blood clot.
• Drainage: a procedure to drain fluid from the brain.
• Pressure relief: a procedure to stop pressure from building up inside the skull or brain.

While in the hospital, a healthcare team of doctors, specialists, and therapists will help the patient start their recovery. Long-term treatments may include:

• Anticoagulants to stop blood clots from forming.
• Medicines to lower blood pressure.
• Statins to lower cholesterol.

Ongoing stroke treatment and recovery

The faster a stroke patient receives treatment, the better their chances of recovery. Treatment depends on the type of stroke, the time elapsed since the onset of symptoms, and the patient's other medical conditions.

Ischemic Stroke Treatment

Ischemic strokes, which are caused by a blockage, are the most common type of stroke, constituting an estimated 87% of all stroke cases. The primary treatment for this type of stroke is a medicine called tissue plasminogen activator (tPA), which breaks up blood clots and must be administered within a three-hour window from the onset of symptoms. This medication can also be given up to 4.5 hours after the symptoms begin if the patient woke up with stroke symptoms. If tPA treatment is not possible, anticoagulants or blood-thinning medications, such as aspirin or clopidogrel, may be given to stop blood clots from forming or growing larger.

In addition to medication, procedures such as thrombectomy, angioplasty, and stenting may be performed to open up blocked arteries and restore blood flow to the brain. Thrombectomy involves removing the clot from the blood vessel using a catheter, while angioplasty and stenting use a balloon or a small mesh tube to clear space for blood flow.

Hemorrhagic Stroke Treatment

Hemorrhagic strokes, caused by bleeding in the brain, are less common but more deadly. Treatment for this type of stroke depends on the location and extent of bleeding in the brain. Lowering blood pressure is crucial to reduce the strain on the blood vessels in the brain. Any anticoagulant or blood-thinning medications that may have contributed to the bleeding are discontinued, and vitamin K may be given to aid in stopping the bleeding.

Several procedures may be used to treat hemorrhagic strokes, including aneurysm clipping, coil embolization, and surgery to remove pooled blood or reduce intracranial pressure by temporarily removing part of the skull.

Rehabilitation

The rehabilitation process typically begins as soon as possible after the initial treatment, often within 24 hours of a stroke. The rehabilitation team includes physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses. The typical length of a hospital stay after a stroke is five to seven days, during which the team evaluates the effects of the stroke and develops a rehabilitation plan.

Rehabilitation focuses on activities of daily living (ADL), such as bathing and preparing food, as well as addressing cognitive and emotional impacts. Physical and occupational therapy helps determine which areas of the brain are affected and aids in recovery. Speech-language therapy is crucial for patients with swallowing difficulties.

The first three months after a stroke are the most critical for recovery, with most patients entering and completing an inpatient rehabilitation program or making significant progress in outpatient therapy. During this period, patients may experience spontaneous recovery, where lost skills or abilities suddenly return as the brain finds new ways to perform tasks.

Even after six months, improvements are still possible, but they will be slower. It is important for patients to continue following up with their care team, including their primary care physician, rehabilitation physician, therapists, neurologist, and rehabilitation psychologist, to maximize their recovery and address any ongoing impairments or chronic stroke disease.

While the recovery journey may be slow and uncertain, with challenges and setbacks along the way, it is important to remain hopeful and focused on achieving milestones, no matter how big or small.

The benefits of stroke treatment centres

Stroke treatment centres offer a wide range of benefits to patients who have suffered a stroke or are at risk of having one. Here are some of the key advantages:

Timely and Effective Treatment

Stroke treatment centres are equipped with the latest technologies and a team of specialists, including vascular neurologists, who are trained in the most advanced techniques for stroke care. This expertise enables them to provide timely and effective treatment options, such as thrombolytic drugs, thrombectomy procedures, and blood pressure management, all of which can significantly improve patient outcomes.

Comprehensive Care

These centres offer a comprehensive range of services, from emergency treatment to long-term rehabilitation. This includes diagnostic services like scans and blood tests, as well as rehabilitation therapies such as physiotherapy, speech and language therapy, and psychological counselling. This holistic approach ensures that patients receive the full spectrum of care they need during their recovery journey.

Specialist Expertise

Vascular neurologists, also known as stroke doctors, have extensive experience in managing strokes and their risk factors. They undergo additional subspecialty training focused on interventional treatments and the latest techniques in stroke care. This means that patients have access to highly specialised professionals who can provide tailored advice and treatment plans, including assessing the risks and benefits of various treatment options.

Continuity of Care

Stroke treatment centres often work in conjunction with other healthcare providers, including the patient's primary care physician, therapists, and other specialists. This collaborative approach ensures continuity of care, allowing patients to receive ongoing support and treatment as they transition from emergency care to rehabilitation and long-term management of their condition.

Access to Cutting-Edge Technologies

Stroke treatment centres are at the forefront of technological advancements in stroke treatment. They have access to innovative procedures, such as microcatheter-based surgical interventions, clot retrieval devices, and endovascular treatments. These technologies increase the chances of successful stroke treatment and improve patient outcomes, even in complex cases.

Patient Choice and Flexibility

Private stroke treatment centres offer patients more choice and flexibility in their treatment journey. Patients can choose the location and timing of their treatment, as well as select specific specialists they wish to work with. This level of customisation allows patients to take greater control of their healthcare decisions and tailor their treatment experience to their individual needs and preferences.

Frequently asked questions