A stroke (hemorrhagic or ischemic) typically manifest itself by the sudden onset of focal neurologic deficits. Ischemic strokes can be due to thrombosis, embolism or hypoperfusion; hemorrhagic strokes can be intraparenchymal or subarachnoid. As with all other aspects of medical treatment, an accurate diagnosis is essential prior to instituting appropriate treatment. Evaluation includes laboratory as well as imaging studies. laboratory studies include:
Complete blood count (CBC)
Glucose and electrolytes
Prothrombin time (PT)
Activated partial thromboplastin time (aPTT)
Cardiac enzymes
Arterial blood gases
Additional studies tailored to each individual patient
Imaging studies for the evaluation of an acute stroke include:
CT (computed tomography)
CTA (computed tomography angiography)
MRI (magnetic resonance imaging)
MRA (magnetic resonance angiography)
Digital substraction angiography
Carotid duplex scanning
Transcranial Doppler ultrasonography
Additional studies tailored to each individual patient
The goal of acute stroke management is to minimize the damage and increase the chances for recovery. Consultation with experienced professionals familiar with the acute management of stroke is paramount. Therapy should be initiated at once following diagnosis. Treatment such as thrombolytic therapy should be administered within one hour following presentation for care. Consultations should not be delayed for the convenience of the medical provider. Experienced care for stroke victims should be available within 15 minutes of the patient's arrival to the hospital.
The administration of recombinant tissue plasminogen activator (tPA) has revolutionized the acute management of stroke. Currently, tissue plasminogen activator (tPA) is the only approved therapy for acute ischemic stroke. It requires that a stroke be promptly diagnosed and treated as a time- critical emergency. The report from the National Institute of Neurological Disorders and Stroke (NINDS report) demonstrated substantial benefit from the intravenous administration of tissue plasminogen activator (tPA) to a selected group of patients with acute ischemic strokes of less than 3 hours duration from its onset.
Some patients with intracerebral hemorrhage or hemorrhagic transformation following thrombolytic therapy may benefit from surgical intervention. If neurosurgical consultation and care is not available on a timely basis, transfer to an appropriate facility is indicated.
Management of a patient with an acute stroke is a team effort that includes all medical providers. Time is of the essence. Excessive time in the emergency room waiting room or delay in evaluation and treatment can result in a catastrophic outcome.
If you are suffering from complications due to a delayed diagnosis of a stroke, or the failure to evaluate and treat a stroke, let Dr. Borten and the Boston area medical malpractice attorneys at Gorovitz & Borten review the specifics of your case. At Gorovitz & Borten we have the necessary experience, understanding and resources available to properly evaluate the complications of a stroke, and give you a timely assessment of its merits.
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