Diagnosis and Treatment of Stroke in the Stroke Care Unit: Current Status and Problems in the National University Hospital

Abstract

Stroke remains the second or third cause of death and a major cause of adult disability in Japan. Management of stroke patients should be done in the Stroke Center or the Stroke Care Unit with their highly specialized diagnostic and treatment teams. A Stroke Care Unit (SCU) was opened in the Tokushima University Hospital in November 1999.
The diagnostic category of 295 stroke patients registered in our SCU until September 2002 was cerebral infarction in 175 patients (59.3%), intracerebral hemorrhage in 55 patients (18.4%), subarachnoid hemorrhage in 36 patients and others in 29 patients (9.8%). Stroke MRI combined with diffusion-weighted MRI (DWI), perfusion-weighted MRI (PWI), T2-weighted MRI and MR angiography were useful in detecting early cerebral ischemic lesions and evaluating indication of thrombolysis.
Thirty-seven (21.1%) of 175 patients with ischemic stroke underwent surgical or endovascular reconstruction. However, the outcome of the patients with embolic occlusion of the internal carotid arteries or proximal middle cerebral arteries was still unsatisfactory.
We discuss the significance and problems in the SCU of the National University Hospital.