Social problems in the management of acute ischemic stroke

Purpose

The efficacy of thrombolysis, systemic t-PA or local transarterial urokinase infusion in the ischemic stroke of acute stage has recently been proved. However, the patients brought to the stroke center during the 'Golden time' are still not numerous. To elucidate this problem, we analyzed the process until hospitalization after the onset of symptoms.

Methods

The clinical subjects consisted of 335 consecutive patients with ischemic stroke in the acute stage, hospitalized in our hospital, between April 2003 and March 2004. We investigated clinical course, especially, the time from the onset to the physical examination, and radiological examinations (CT, MRI, MRA and/or cerebral angiography). The mean age was 72.1 years. Among them, 99 patients were classified as atherothrombosis, 72 were cardiac embolism, 134 were lacunar infarction and 30 were transient ischemic attack. Only seven patients underwent local urokinase thrombolysis.

Results

Eighty-six patients (25.7%) were hospitalized within 3 hours from the onset, and 135 patients (40.3%) were within 6 hours. Among these 135 patients, only 58 were admitted by ambulance. We found the following results. The main reason for the delayed admission is through another hospital, not the stroke center. The patients denying their symptoms is not so rare. The patients or their family often hesitate to request the emergency car.

Conclusions

We should educate citizens more for the warning signs of ischemic stroke and also the necessity of emergency admission and therapy. In addition, we should justly build a core stroke center in the district and centralize the patients.