Yale School of Medicine, New Haven, CT (M.L.P.).
Johns Hopkins University Hospital, Baltimore, MD (D.S.).
Stroke. 2022 Mar;53(3):e108-e117. doi: 10.1161/STROKEAHA.121.037297. Epub 2022 Jan 20.
Stroke is the second leading cause of death and disability worldwide, with a disproportionate burden on low- and middle-income countries. Critical elements of guideline-based stroke care developed in high-income countries are not applicable to resource-limited settings, where lack of access to neuroimaging prevents clinicians from distinguishing between ischemic stroke and intracranial hemorrhage, requiring challenging clinical decision-making, particularly in the acute setting. We discuss strategies for acute inpatient management of stroke of unknown type with a focus on blood pressure management and antiplatelet therapy when neuroimaging is unavailable, and review some of the challenges and strategies for successfully implementing stroke unit care in resource-limited health care settings.
中风是全球范围内导致死亡和残疾的第二大原因,中低收入国家的负担不成比例。在资源有限的环境中,高收入国家制定的基于指南的中风治疗的关键要素并不适用,因为无法获得神经影像学检查,导致临床医生无法区分缺血性中风和颅内出血,需要进行具有挑战性的临床决策,特别是在急性情况下。我们讨论了在无法进行神经影像学检查时,针对不明类型中风的急性住院管理策略,重点是血压管理和抗血小板治疗,并回顾了在资源有限的医疗保健环境中成功实施中风单元护理的一些挑战和策略。