Neurology: Stroke services are greatly underdeveloped in the State with patients unable to routinely access the latest clot-busting treatment, a leading specialist has said. Dr Muiris Houston, Medical Correspondent, Medical Correspondent, reports.
Dr Peter Kelly, consultant neurologist and director of the stroke service at the Mater Hospital, Dublin, also called for the development of a national stroke strategy, similar to the cardiovascular and cancer strategies.
Pointing out that acute hospital stroke units are proven to prevent death and disability in one- fifth of stroke victims, Dr Kelly said there was a need for a stroke unit in every acute hospital in the Republic.
Rapid access clinics for patients with warning symptoms of preventable stroke are also required, along with dedicated rehabilitation units.
Some 8,000 people suffer a stroke in the Republic each year. One-quarter of these die; stroke is the third leading cause of death here. About 50 per cent of stroke survivors develop moderate or severe disability. And stroke accounts for 8-10 per cent of admissions through A&E units.
A stroke, also known as a cerebrovascualar accident (CVA), occurs when the brain is starved of oxygen. In an ischaemic stroke, the blood supply to a part of the brain is cut off by a clot. A less common form (haemorrhagic stroke) occurs when blood leaks from an artery into the brain.
Dr Kelly said clot-busting treatment in the form of tissue plasminogen activator (tPA) leads to a full neurological recovery in one in three patients given the drug within 90 minutes of the onset of a stroke.
However, because of the risk associated with tPA, Dr Kelly said it could only be given by senior physicians who are trained in its use.
"This is the block to giving tPA; the more physicians we have trained to give the intravenous treatment, the quicker the logjam will be sorted."
At present there are just three consultant stroke neurologists in the State, which limits the availability of the treatment here.
Dr Kelly said we needed to develop acute stroke teams, made up of highly trained professionals, who will get to patients within the first three hours of a CVA occurring. With one in seven patients achieving full recovery when treated with tPA in the first three hours, "this is the window when we may be able to reverse the effects of a stroke".
He said a stroke unit was the basic infrastructure within the hospital that allowed modern stroke care to occur.
Welcoming the funding of a rapid access service for stroke patients in north Dublin on a pilot basis by the Health Service Executive (HSE), Dr Kelly said it provided protected outpatient slots to GPs when they needed to urgently refer patients with the warning symptoms of a stroke.
"We have seen more than 50 patients since last November in the rapid access clinics and it is working very well," he said.
Calling for the urgent implementation of a national stroke strategy, Dr Kelly said: "Policy-makers and health administrators should immediately prioritise the creation of stroke units in all acute hospitals.