Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
Stroke Vasc Neurol. 2017 Feb 24;2(1):30-39. doi: 10.1136/svn-2016-000041. eCollection 2017 Mar.
Ischaemic stroke is a major cause of neurological morbidity and mortality. The objective of this review article is to summarise facts pertaining to acute ischaemic stroke and its various aspects in a developing country like Pakistan, where resources are limited and the healthcare system is underdeveloped. No large-scale epidemiological studies are available to determine the true incidence of stroke in Pakistan. We reviewed the available literature on stroke from Pakistan and through this article we primarily aim to present the current acute ischaemic stroke management in Pakistan in juxtaposition to that of the developed world. We also intend to highlight areas for future development and improvement in management. The routine practice in Pakistan is that of using stat dose of aspirin in emergency (ER) at large with only a handful of centres offering thrombolytic therapy with recombinant tissue plasminogen activator for acute ischaemic stroke. This too is faced with the problem of long window periods before the patient reaches a proper stroke care centre. The facilities of interventional therapies like arterial thrombolysis and endovascular surgery are non-existent and rehabilitation facilities limited. The opportunities for training physicians in acute stroke are also scarce. Stroke in children is underdiagnosed and that in women not availing facilities at stroke care centres. While basic research has gained pace regarding local demographic data, advanced research and genetic studies are extremely limited. The field of stroke neurology needs to grow at a substantial pace in Pakistan to be at par with the developed world.
缺血性中风是导致神经功能障碍和死亡的主要原因。本文旨在总结在巴基斯坦这样一个资源有限、医疗体系欠发达的发展中国家，与急性缺血性中风及其各方面相关的事实。目前尚无大规模的流行病学研究来确定巴基斯坦中风的真实发病率。我们对来自巴基斯坦的中风相关文献进行了回顾，并通过本文主要介绍巴基斯坦目前急性缺血性中风的管理现状，同时与发达国家进行对比。我们还旨在强调未来管理方面的发展和改进领域。在巴基斯坦的常规做法是在急诊室（ER）大剂量使用阿司匹林，只有少数中心提供重组组织型纤溶酶原激活剂用于急性缺血性中风的溶栓治疗。但这也面临着患者到达适当的中风治疗中心之前，时间窗口过长的问题。介入治疗如动脉溶栓和血管内手术等设施尚未普及，康复设施也有限。培训急性中风医生的机会也很少。儿科中风的诊断不足，以及女性无法获得中风治疗中心的设施。虽然基础研究在当地人口数据方面取得了进展，但高级研究和遗传研究极为有限。中风神经学领域需要在巴基斯坦迅速发展，以达到发达国家的水平。
