Updates on Urgency of Treating Stroke

Citation: Adel Ekladious. Updates on Urgency of Treating Stroke. Biomed J Sci & Tech Res 38(2)-2021. BJSTR. MS.ID.006126.


Introduction
It is a proof of concept that time is muscle in treating myocardial infarction and even if for any reason you missed the boat in timely management of heart attack, we postulate that probably you might have a second chance which is heart transplant if patient meets the requirement, and this is not an excuse for not treating the heart attack very urgently [1]. The situation in stroke is more serious and more urgent [2] as you need to exclude stroke mimics in a very short time to make a therapeutic decision, in a large vessel stroke [middle cerebral artery stroke]. There is a loss of 2 million nerve cells per each minute delay [3] which is correlated with loss of 1.8 days of healthy life [3], After saucerful treatment of heart attack you can still run a marathon in contrast of stroke that you might need to lose few brain cells to be in a vegetative state. Most of strokes are ischemic, around 80%, less than 15% are hemorrhagic, and less than 2% are venous stroke (cortical or cerebral venous stroke) [4].
Treatment of each type of stroke is quite different, and all types of strokes is emergency and needs to confirm the diagnosis.

Mini Review
In this review, i am going to discuss the updates of investigation and specific physical signs and symptoms which help to reach a correct diagnosis in a very short time, and iniate urgent treatment.
Firstly, diagnosis of stroke and ruling out stroke mimics is of para-amount importance, Seizure, manganous Aurea, cardiogenic and metabolic syncope, encephalitis, demyelination, infective endocarditis and embolic stroke, metabolic encephalopathy, need to be ruled out some tips to exclude mimics. usually resolve in few hours [5].
b) Migranous Aurea, history of migraine, fortification spectra, Aurea could be in language and pronunciation, sensory, motor, usually it is slowly progressing, each one modality happened in one time then followed by another modality, patient could have nausea [6], patient with basilar migraine might have ptosis or Horner syndrome [7].  [9].
Sometimes confirming the diagnosis of stroke will be difficult, here we are presenting other tools which help the diagnosis of stroke and the pathology of stroke to help starting an early treatment.

1.
The definition of TIA as clinical symptoms which last less than 24 hours is outdated [10] because MRI can confirm a diagnosis of stroke even if the clinical symptoms last less than 60 minutes [11].

2.
Restriction diffusion in DWI can diagnose stroke even after one minute of having the symptoms and cytotoxic oedema can be confirmed by ADC [12].

3.
Biomarkers in Ischemic Stroke, S100B and specific enolase are proteins measured from serum and correlate very well with the volume of stroke 24-27 hours [13]. Is a surrogate marker of the time of onset of stroke [14] specially in wake-up stroke?. Endovascular therapy is a standard of care for proximal large vessel occlusion, therapeutic window is up to 12 hours [15]. Venous stroke is an emergency, it affects mostly females, usually presented with seizure, decreased level of consciousness due diffuse encephalopathy, signs of increased intracranial pressure, headache, cranial nerve palsy, It is underdiagnosed because of the rarity of the stroke.  [19].