Ischemic stroke in hospitalized patients. The modern view on the problem

Abstract

Hospitalized patients are at higher risk of ischemic stroke than in the general population in the population. Inhospital ischemic stroke is one of the most serious complications developing in the hospital, and it is associated with a greater number of adverse outcomes compared with community-acquired stroke. According to the literature, there are several reasons for this fact. The most common pathogenic subtype of in-hospital ischemic stroke is cardioembolic subtype, characterized by extensive ischemic damage to brain tissue. Approximately 50% of hospitalized patients have proven the fact of cardiac embolic source. Also in-patients are characterized by the greater comorbidity and a higher risk of somatic diseases, which also have an adverse effect on the course of a stroke. And finally, in-hospital stroke is characterized by delays at all stages of urgent medical care compared to patients admitted to hospital with a diagnosis of stroke urgently through the emergency department. The most common reasons for these delays include the obvious difficulties of clinical diagnostics, the complexity of in-hospital logistics, lack of early recognition of stroke symptoms skills and lack of understanding of the paradigm of «time-to-brain» in choosing of the treatment strategy by physicians with other medical specialties. Lost time, in addition to the existing contraindications for thrombolytic therapy system, is the main reason for the low number of procedures thrombolysis in patients with in-hospital stroke. As a consequence, the treatment of patients with in-hospital stroke requires more economic cost. These patients have longer periods of hospitalization, and after discharge they often require the continuation of treatment in rehabilitation centers and social support measures. Researchers agree that improvement of the quality of care for patients with in-hospital stroke requires designing of special protocols on the similarity of those that are designed to assist patients urgently admitted with a diagnosis of stroke, as well as holding regular sessions with staff on the practicing of hospitals stroke diagnostic skills and the course of action of medical personnel in case of stroke.

Keywords

in-hospital ischemic stroke / cardioembolism / systemic thrombolysis / endovascular recanalization / comorbidity / disability / stroke treatment protocol / stroke register / postoperative cerebral dysfunction

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