New and Advanced Treatments for Strokes | Dr. Prem Pillay, Singapore
Strokes remain an increasing and important cause of significant disability and death in most developed countries. It cannot be overlooked in developing countries as well. Ischemic stroke needs to be quickly identified and treated with anti-platelet and anti-coagulant therapy. Patients with TIAs and RINDs should be effectively screened with MRA and DSA for treatable carotid artery stenosis.
New options include angioplasty and stenting for selected patients. Even selected patients with stroke syndromes may benefit. Cerebral revascularization procedures may still be of benefit to carefully selected patients. Clearly patients with Moya-moya disease and stroke can benefit as well from EMAS procedures. Omental transfer is another method of cerebral revascularization that is being explored.
Patients with hemorrhagic strokes should receive ICU care and early detection with CT scans is essential. Selected patients can benefit from surgery including Stereotactic/computer aided Needle hematoma aspiration and microsurgical hematoma evacuation. SAH from brain aneurysms should be identified early with brain scans. Patients may benefit from external ventricular drainage and early surgical clipping of aneurysms. Selected patients may also derive benefit from endovascular procedures such as GDC coiling without needing to undergo major cranial surgery.
Patients with hemorrhage from AVMs should also be diagnosed early with CT, MRI, and DSA. Some patients required early surgery including microsurgery. Selected patients will benefit from embolization and others from Radiosurgery.
Rehabilitation from stroke is essential to ensure that patients can maximize their potential for recovery.
Clinicians including family doctors, emergency room physicians, internists, neurologists and neurosurgeons should keep up to date on the latest trends in Stroke care so that their patients will receive earlier, and more appropriate care.