Review of acute ischaemic stroke in Pakistan: progress in management and future perspectives

Abstract

Ischaemic stroke is a major cause of neurological morbidity and mortality. The objective of this review article is to summarise facts pertaining to acute ischaemic stroke and its various aspects in a developing country like Pakistan, where resources are limited and the healthcare system is underdeveloped. No large-scale epidemiological studies are available to determine the true incidence of stroke in Pakistan. We reviewed the available literature on stroke from Pakistan and through this article we primarily aim to present the current acute ischaemic stroke management in Pakistan in juxtaposition to that of the developed world. We also intend to highlight areas for future development and improvement in management. The routine practice in Pakistan is that of using stat dose of aspirin in emergency (ER) at large with only a handful of centres offering thrombolytic therapy with recombinant tissue plasminogen activator for acute ischaemic stroke. This too is faced with the problem of long window periods before the patient reaches a proper stroke care centre. The facilities of interventional therapies like arterial thrombolysis and endovascular surgery are non-existent and rehabilitation facilities limited. The opportunities for training physicians in acute stroke are also scarce. Stroke in children is underdiagnosed and that in women not availing facilities at stroke care centres. While basic research has gained pace regarding local demographic data, advanced research and genetic studies are extremely limited. The field of stroke neurology needs to grow at a substantial pace in Pakistan to be at par with the developed world.

Awareness of Stroke and Health-seeking Practices among Hypertensive Patients in a Tertiary Care Hospital: A Cross-sectional Survey

“…Tissue plasminogen activator, as a registered medical product by the Ministry of Health Pakistan, has extremely limited availability. Efforts are being made by the neurologist community in Pakistan to address this lack of availability [11]. However, before thrombolysis can be the norm for treatment for acute stroke, public understanding of stroke and its risk factors and warning signs has to improve.…”

Ischemic Stroke

“…Stroke Risk in Atrial Fibrillation Working Group found that for patients with AFib and hypertension, the risk of stroke increases 1.6 to 2.5 times compare with patients without AFib. 29 They also found that a history of hypertension and systolic blood pressure >160 mm Hg was independently and separately associated with an increased risk of www.theprofesional.com ISCHEMIC STROKE 88 5 stroke in patients with AFib. 29 Hyperthyroidism in our study was present among 4.5% patients with atrial fibrillation.…”

Pneumonia

“…These risk factors are well known and can be modifiable and non-modifiable. [3][4][5] Older age and 2 atrial fibrillation were independently associated with greater risk for developing pneumonia in California Acute Stroke Prototype Registry. Other factors include atrial fibrillation and dyslipidemia.…”