Emergency Management Of Stroke Research Articles

Application of Machine Learning Techniques for Characterization of Ischemic Stroke with MRI Images: A Review.

Magnetic resonance imaging (MRI) is a standard tool for the diagnosis of stroke, but its manual interpretation by experts is arduous and time-consuming. Thus, there is a need for computer-aided-diagnosis (CAD) models for the automatic segmentation and classification of stroke on brain MRI. The heterogeneity of stroke pathogenesis, morphology, image acquisition modalities, sequences, and intralesional tissue signal intensity, as well as lesion-to-normal tissue contrast, pose significant challenges to the development of such systems. Machine learning (ML) is increasingly being used in predictive neuroimaging diagnosis and prognostication. This paper reviews image processing and machine learning techniques that have been applied to detect ischemic stroke on brain MRI, including details on image acquisition, pre-processing, techniques to segment, extraction of features, and classification into stroke types. The main objective of this work is to find the state-of-art machine learning techniques used to predict the ischemic stroke and their application in clinical set-up. The article selection is performed according to PRISMA guideline. The state-of-the-art on automated MRI stroke diagnosis, with a focus on machine learning, is discussed, along with its advantages and limitations. We found that the various machine learning models discussed in this article are able to detect the infarcts with an acceptable accuracy of 70–90%. However, no one has highlighted the time complexity to predict the stroke in the model developed, which is an important factor. The work concludes with proposals for future recommendations for building efficient and robust deep learning (DL) models for quantitative brain MRI analysis. In recent work, with the application of DL approaches, using large datasets to train the models has improved the detection accuracy and reduced computational complexity. We suggest that the design of a decision support system based on artificial intelligence (AI) and clinical data presenting symptoms is essential to support clinicians to accelerate diagnosis and timeous therapy in the emergency management of stroke.

Emergency management of stroke in the era of mechanical thrombectomy.

Emergency management of stroke has been directed at the delivery of recombinant tissue plasminogen activator (tPA) in a timely fashion. Because of the many limitations attached to the delivery of tPA and the perceived benefits accrued to tPA, its use has been limited. Mechanical thrombectomy, a far superior therapy for the largest and most disabling strokes, large vessel occlusions (LVOs), has changed the way acute strokes are managed. Aside from the rush to deliver tPA, there is now a need to identify LVO and refer those patients with LVO to physicians and facilities capable of delivering urgent thrombectomy. Other parts of emergency department management of stroke are directed at identifying and mitigating risk factors for future strokes and at preventing further damage from occurring. We review here the most recent literature supporting these advances in stroke care and present a framework for understanding the role that emergency physicians play in acute stroke care.

Emergency Management of Stroke

A stroke takes place when the blood supply to the brain is interrupted or there is bleeding in the brain. Within a short time, brain cells starts to die. It is critical to seek emergency care at the first sign of a stroke. Early treatment saves many lives and decreases the effects of stroke. If brain cells die or are damaged as a consequence of a stroke, symptoms take place in the parts of the body that these brain cells control. Examples of stroke symptoms comprised sudden weakness, paralysis or numbness of the face, arms, or legs (paralysis is an inability to move), trouble speaking or understanding speech and trouble seeing. A stroke is a serious medical condition that requires emergency care and may cause lasting brain damage, long-term disability or even death.

Management of acute ischemic stroke: current status of pharmacological and mechanical endovascular methods

Objective: To provide the current strategies of acute stroke management using pharmacological and interventional endovascular modalities.Methods: Review of the literature for publications in English language literature on endovascular pharmacological and mechanical thrombolysis and clot retrieval.Results: Aggressive management protocols have yielded therapeutic windows for effective reperfusion of ischemic brain in acute cerebral hypoperfusion/stroke. Starting with intravenous infusion of thrombolytics, which still remains to be the best feasible treatment for acute stroke management, recent advances in neuron imaging made it possible to utilize emergency cerebral angiographic evaluation of intracranial vessels followed by therapeutic measure that could be pharmacological or mechanical intervention. Intra-arterial clot lysis under image guidance combined with intravenous administration of thrombolytic is rapidly evolving with encouraging results. Microcatheters and endovascular appliances tested very positively, yielding better outcomes in acute stroke. MERCI trial, Multi MERCI trial and Stroke trials [emergency management of stroke (EMS) and interventional management of stroke (IMS)] have shown that early recanalization and reperfusion constitute good prognostic indicators by reducing mortality and improving neurological outcomes. Further trials are expected to yield better evidence to form guidelines for aggressive management of acute cerebral ischemia.Discussion: Intravenous fibrinolysis is, to date, the best possible intervention in acute stroke and has been shown to be a better alternative to aspirin, the only known effective, pharmacological treatment. Endovascular interventions have shown very promising results with intra-arterial administration of thrombolytics as well as mechanical clot retrieving methods.

DIAGNOSTIC EVALUATION OF STROKE

Diagnostic testing in patients with ischemic stroke serves many purposes, including confirmation of the diagnosis and providing clues as to possible causes. Evaluation of the cerebral vasculature, the heart, the blood coagulation system, and selected other diagnostic tests may point to a mechanism of stroke which helps determine treatment and prognosis. With the recent advent of acute interventions for ischemic stroke, diagnostic testing is now an important component in the emergency management of stroke. In this article, the authors will review the standard approach to diagnostic testing for patients with ischemic stroke or transient ischemic attack, and new developments in neuro-imaging and their use in acute stroke assessment.