Background: Stroke is the second leading cause of chronic disability and death in the world. Educating the public and physicians about stroke-related symptoms are critical success factors in early stroke treatment. Aim: This study was carried out in order to assess acute stroke management strategies in a teaching hospital. Patients and Methods: The study included all consecutive patients admitted to the general medical ward during the period of March to November 2008 who had a diagnosis of acute stroke. The total number was 217 patients, presumed to have stroke during their initial evaluation in the emergency room. However, ward evaluation confirmed only 193 patients to have a diagnosis of acute stroke (sudden onset of any neurological deficit). Brain imaging was performed in 167 out of the 193 patients. Results were obtained for 140 patients. Results: The age of those with clinical and radiological evidence of acute stroke (n=140) was 65±12 years. Sixty-five were females. The median time elapsed between the onset of symptoms and the arrival to the hospital was 12 hours (range: 1-336 h). Females presented earlier than males (19 hours versus 35 hours; p<0.05). Forty-eight patients (34%) presented within the first four hours and 71 (51%) arrived after eight hours, whilst 8 patients (6%) were not able to determine the time of onset of symptoms. The mean time for brain image from hospitalization was 3.5±2.3 days with no gender difference. Ischemic infarction was reported in 104/140 (74%) patients, intracerebral hemorrhage was reported in 16 (11%) patients and brain ischemia with hemorrhagic transformation was reported in 14 (10%). Normal brain images were found in 6 (5%) patients. 108 patients (78%) received in-hospital aspirin treatment with a mean time to start aspirin 1.2±1.4 days. The mean length of stay in hospital was 7.5±3.7 days. Ninety-nine (80%) of the patients were discharged on aspirin. The in-hospital outcome was assessed by the Rankin Disability Status scale as static course (in 107 patients; 85%), improvement of neurological function (in 10 patients; 8%), deterioration of neurological function (in 1 patient; 1%), or death (in 8 patients; 6%). Conclusion: Hospital arrival and performance of brain image were both delayed. Delayed arrival was attributed to lack of ambulance with direct transportation to the acute care hospital, waiting at the emergency department, and public's unawareness of stroke symptoms. The delay in performing brain image is the limited access to CT/MRI facility on site and out of hours. Public and professional education campaign coupled with an effective acute treatment strategies are urgently needed.
Key-words:
Cerebrovascular disease - Epidemiology - Presentation time - Thrombolysis
