Op-Ed: Treating Stroke Requires a Team of Specialists

And yet those specialists fail 88% of the time in getting patients fully recovered when tPA is given.  And that doesn't even consider the fact that only a miniscule percentage of patients that should get tPA actually get tPA.  We haven't even mentioned that only 10% of stroke survivors get fully recovered. THIS IS WHY I CONSIDER EVERYTHING IN STROKE A FAILURE.  No one is addressing any of these massive failures in stroke.  Check out these 13 problems in stroke with nothing to address them. Survivors are just supposed to accept that stroke is so fucking hard to solve that your disability for life is an acceptable consequence. Everybody in stroke needs to be fired, specially when they write back patting articles like this. .

Op-Ed: Treating Stroke Requires a Team of Specialists

A multifaceted approach for a multifaceted disease

by Jeremy Payne, MD, PhD July 13, 2020

A woman experiencing progressive confusion, disorientation, and finally severe hallucinations was placed in a locked psychiatric unit, where she declined rapidly.
Only when the woman exhibited facial weakness and numbness did her physicians order brain imaging and discover she had experienced a series of small strokes.
When she was eventually brought to our stroke center, our team of specialists quickly made a diagnosis of vasculitis, a rare immune condition that attacks the arteries, ultimately damaging the brain. In retrospect, her symptoms were quite classic, but by then our diagnosis was too late.
While the woman's disease was rare, this outcome was not.
Too often, stroke patients are initially sent to the wrong place. Sudden loss of vision, for example, typically results in referral to an ophthalmology clinic, although this can be a common emergent stroke symptom, too.
When a patient presents to a physician's office with a history suggestive of stroke, a common community practice is to refer to a cardiologist. Only a fraction of strokes are actually directly related to the heart, however. Hypertension is a common disease but may not actually have a bearing on the reason any particular patient has a stroke.
While there is significant overlap in the risk factors for brain and cardiac vascular disease, there are many important exceptions.
Stroke can be particularly tricky because it can present with various symptoms that mask its true cause. The symptoms result from sudden loss of function in part of the brain when its blood supply is interrupted and can be as varied as the brain's function itself.
The ideal strategy for diagnosis and treatment of brain vascular disease requires a multidisciplinary team, preferably led by a vascular neurologist.
Stroke is a multifaceted disease. As we learn to better leverage connections across clinical disciplines, we will better serve these patients. I encourage all clinicians to reach out to vascular neurologists at primary and comprehensive stroke centers, both for emergent cases and for assistance in ensuring outpatients are afforded a thorough evaluation and plan of care.
Such centers are designed to harness the knowledge of multiple clinical disciplines under the direction of vascular neurology specialists. Certified comprehensive stroke centers, in particular, offer a complete range of diagnostic and treatment strategies.(The operative word here is strategies NOT RESULTS!)
Jeremy Payne, MD, PhD, is the director of the Comprehensive Stroke Center at the Banner-University Medicine Neuroscience Institute in Phoenix.