An ordinary meeting of the Society took place on 3rd November. The President was in the chair. The minutes of the previous meeting were signed. The President announced the deaths of Dr Peter Todd and Professor Jack Howell.
The talk was given by Dr Pamela Crawford, Stroke Physician at Southampton General Hospital, who spoke on the Modern Management of Stroke. She did this by going through seven different clinical scenarios.
They now have a co-ordinated team at the Southampton University Hospital and, like most DGH's, can offer a 24 hour thrombolysis service. However, thrombolysis is not suitable for all patients. If given more than 6 hours after the stroke, it can be harmful. It is not without risk and because of this Dr Crawford often has quite difficult ethical discussions to have with patients, or their families if the patient's comprehension is impaired. A CT scan is rapidly performed after admission, the Ambulance Service having pre-warned the ED that a probable stroke case would be arriving. The Median time to CT from arrival in ED is 18 minutes. If the CT indicates a bleed then a follow up MRI is organised as a bleed can conceal an underlying tumour early on. If someone presents and is appropriate for thrombolysis, and can be treated within 90 minutes, which is by no means unusual, the Numbers needed to treat (NNT) in order to get an “excellent” outcome are only 5, which compares well with any cardiological interventions, she said.
Someone with a small lacunar infarct can be admitted, scanned, treated, have their risk factors addressed and be home the same day with community Stroke Team follow up. Review by the specialist nurse is at 6w and 6m. Patients admitted to the stroke unit all have a swallowing assessment as pneumonia is a common cause of death.
Atrial Fibrillation causes big clots and therefore big strokes. For some cases clot retrieval can work, but this requires the availability of an interventional neuroradiologist and an anaesthetist.
If there is doubt about the amount of ischaemic, but not yet dead, brain that is present, a perfusion scan can help differentiate, and inform the decision as to further management.
In younger patients in whom brain swelling can cause death, a hemicraniotomy can be performed. The portion of removed skull is kept within the abdomen and can be re-implanted later, though this does not always go smoothly. This saves lives but patients are usually left with residual disability.
After the talk there were many questions, which Dr Crawford kindly answered. She was thanked for her very interesting presentation and there being no other business, the meeting closed at 10.15pm.