Management of hyper-acute Ischaemic Stroke: Current status, challenges and opportunities in Northern Sri Lanka

Abstract

Stroke is one of the leading causes of chronic disability and death worldwide1. However, over the last two decades, this trend has been changed by twin advancement in management of acute ischeamic stroke (AIS); especially in thrombolytic therapy and multidisciplinary dedicated stroke unit2. AIS is distinguished by the sudden loss of neurological functions due to acute interruption of blood circulation to an area of the brain. It is commonly caused by thrombotic or embolic occlusion and less often by rupture of a cerebral artery. Stroke is the fourth commonest killer and major cause of disability among adults in Sri Lanka3. Annual expenditure on the management of acute stroke and neuro rehabilitation has been mounting due to increasing cardiovascular risk factors such as hypertension, smoking, diabetes mellitus, dyslipidemia, excessive alcohol intake and sedentary lifestyle concomitantly with ageing population3. There has been an increasing trend of all the above-mentioned non communicable diseases in recent past in North, mainly because of sudden lifestyle transformation by adopting habits introduced by visiting diaspora. Thrombolytic management at dedicated stroke unit plays a crucial part in minimizing its serious outcomes. This paper primarily reviews the indications and contraindications in choosing patients for the administration of intravenous Recombinant tissue plasminogen activator (rtPA), facilities currently available but underutilized, and the challenges faced in AIS management in Northern part of Sri Lanka.