Stroke represents the most common neurological emergency and is one of the leading causes of mortality and morbidity worldwide. In this context, 85% of all strokes are ischemic, and the extent of tissue damage as well as the functional outcome, which is crucial for the patient, depend significantly on the ischemia time and the available collateralization. The term “time is brain” is based on the concept of the ischemic penumbra, which is defined as a functionally altered but structurally (still) intact brain area that usually surrounds the infarct core.
In addition to evidence-based intravenous thrombolytic therapy in a 4.5-hour time window, interventional endovascular therapeutic approaches exist for proximal vessel occlusions, for example. At the same time, the quality of the examinations and the resulting therapy decisions must not suffer under any circumstances due to the time pressure. In particular, frantic overzealousness must not lead to undifferentiated lysis treatments of so-called stroke mimics, such as focal epileptic seizures. In addition, with improved cerebral imaging capabilities, there is increasing evidence recently that the localization of penumbra tissue is of at least as critical importance to functional outcome after stroke as is the time factor.
This makes the expert acute assessment and treatment of stroke patients all the more important. Optimally, this should take place within the framework of certified, neurologically managed stroke centers and stroke units or, in peripheral smaller hospitals, within the framework of telemedical cooperation with stroke centers in order to provide all citizens with access to high-quality interdisciplinary stroke medicine as comprehensively as possible.
The time factor is a very important one in the treatment of acute stroke patients, the “time is brain” concept is valid. But time is not everything; the patient must also arrive at the right place as quickly as possible!
We wish you an exciting read with this issue of InFo NEUROLOGIE & PSYCHIATRIE!
Prof. Dr. med. Erich Seifritz
Prof. Dr. med. Barbara Tettenborn
InFo Neurology & Psychiatry 2014; 12(2): 1.
