Videoconferencing can increase patient access to stroke specialists; immediate, thorough testing needed after “warning” strokes

From The American Heart Association:

High-quality videoconferencing can increase patient access to stroke specialists, especially in rural or other underserved areas; and a transient ischemic attack (TIA), once known as a “mini” or “warning” stroke, should be treated with the same urgency as a full-blown stroke, according to two separate scientific statements and a policy statement published today in Stroke: Journal of the American Heart Association.

A new scientific statement says a remote exam using high-quality videoconferencing equipment is as effective as a bedside stroke evaluation.

Physicians must quickly evaluate stroke patients to determine if they’re eligible for time-sensitive treatment such as tissue plasminogen activator (tPA) that can save brain function and reduce disability. Stroke and brain imaging specialists are often required to perform the evaluation. However, the United States has only an average of four neurologists per 100,000 people, and not all of them specialize in stroke, according to the statement.

Telemedicine, or telestroke, uses interactive videoconferencing via webcams connected to a TV or computer screen, which allows the patient, family and the bedside and distant healthcare providers to see and hear each other in full color and in real time.

Telestroke is coupled with teleradiology, which allows remote review of brain images. This technology can broaden the reach of neurologists in a cost-effective and time-efficient manner.

“Telemedicine is an effective avenue to eliminate disparities in access to acute stroke care, erasing the inequities introduced by geography, income or social circumstance,” said Lee Schwamm, M.D., lead author of a scientific statement and policy statement on telemedicine, and associate professor of neurology at Harvard Medical School and Vice Chairman of Neurology at Massachusetts General Hospital.

Stroke Group Expands Time for Clot-Busting Drugs

From JEMS:

A change to stroke treatment guidelines is expanding the time that some patients can get clot-busting drugs. Current recommendations limit the use of the medicine to within three hours after the start of stroke symptoms. That treatment window is now being lengthened to 4 1/2 hours for some patients.

But the committee that made the change stressed that the earlier the treatment, the better for stroke victims.

“They should call the ambulance straight away and get moving,” said Dr. Gregory del Zoppo, of the University of Washington School of Medicine in Seattle, who headed the committee for the American Heart Association Stroke Council.

The update, published online Thursday in the heart group’s journal Stroke, comes after a European study last fall found stroke sufferers still benefited from getting the medicine an hour or so beyond the three-hour window.

The new guideline is expected to increase the number of people who get the treatment. Only about a third of stroke sufferers get help within three hours, and only about 5 percent get the drug now. Many people don’t recognize the signs of a stroke: numbness or weakness in the face, arm or leg; trouble speaking, seeing or walking; a sudden, severe headache.

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