The past 15 years have witnessed significant strides in the management of acute stroke. The most significant advance, reperfusion therapy, has changed relatively little, but the integrated healthcare systems-stroke systems-established to effectively and safely administer stroke treatments have evolved greatly. Driving change is the understanding that "time is brain." Data are compelling that the likelihood of improvement is directly tied to time of reperfusion. Regional stroke systems of care ensure patients arrive at the most appropriate stroke-capable hospital in which intrahospital systems have been created to process the potential stroke patient as quickly as possible. The hospital-based systems are comprised of prehospital care providers, emergency department physicians and nurses, stroke team members, and critical ancillary services such as neuroimaging and laboratory. Given their complexity, these systems of care require maintenance. Through teamwork and ownership of the process, more patients will be saved from potential death and long-term disability.

Background: Stroke is the third leading cause of death and the major cause of long-term disability in the United States. Timely recognition of symptoms is critical. Family members are crucial in recognizing stroke symptoms since <5% patients can call Emergency Medical Services themselves due to inability to speak or dial the phone. This might be of significance, especially, in family units where children have frequent contact with multiple generations. This study was undertaken to assess and improve the knowledge about stroke amongst children. Methods: A community-based interventional study was conducted among 305 kids ranging from second to eighth grade. A pre-test questionnaire was administered and later health education regarding stroke was imparted using audiovisual aids. Post-test was done to assess the impact of stroke education. Components of education included were: 1) What is stroke? 2) FAST mnemonic. 3) Time sensitive treatment. 4) Risk factors for stroke 5) How can they help? 6) Whom to call and where to go? The data was compiled and analyzed using Chi square test. Results: There was a significant lack of knowledge in the pretest groups. The post-test showed statistically significant improvement in all the tested components irrespective of age or grade (p<0.001). Conclusion: Targeting the younger generation for stroke education is one way to improve community knowledge of stroke symptoms thus increasing the chances that the stroke patient may receive acute stroke therapy. Children can also be used as a conduit to transmit educational information to parents and other family members thus further raising awareness.

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Background: Acute stroke patients with middle cerebral artery (MCA) or intracranial internal carotid artery (ICA) occlusion who have decreased cerebral blood volume (CBV) in the basal ganglia (BG) on CT perfusion (CTP) imaging are thought to be at high risk of intracerebral hemorrhage (ICH) following recanalization with intra-arterial therapy (IAT). We sought to determine if low BG CBV in patients with MCA or ICA occlusion is associated with post-IAT ICH. Methods: This is a single-center retrospective chart review of consecutive stroke patients seen in the emergency room from 6/07 - 12/10. All acute stroke patients with an MCA (M1) or intracranial ICA occlusion on CT angiogram, who underwent CTP imaging and were treated with IAT (IA tpa and/or thrombectomy) were included. The primary outcome was the presence of ICH on CT 24 hours post-IAT. Good clinical outcome was defined as a modified Rankin score ≤ 3 at discharge. Clinical variables, CBV, and ICH were each assessed by investigators who were blinded to the other abstracted data. CBV and ICH were agreed upon by at least 2 readers. Univariate analyses were performed using chi-square tests. Multivariate analyses of other potential predictors of ICH were done using logistic regression. Results: Sixty-two patients were included in these analyses. The mean age was 65.8 years, 44% were male, and 34% were non-white. The mean time to artery recanalization was 717 minutes. In univariate analysis, there was a trend toward higher rates of post-IAT ICH in patients with low BG CBV compared to those with preserved CBV (64.3% vs. 47.1%, p=0.175). Patients with post-IAT ICH had higher rates of a poor outcome than those without ICH (94.1% vs 64.3%, p=0.0031). Multivariate analyses did not demonstrate any independent predictors of ICH. Conclusion: Acute stroke patients with proximal MCA or ICA occlusion and low BG CBV on CTP imaging had a trend toward a higher risk of post-IAT ICH, but this association was not statistically significant, possibly due to the small sample size. Given that ICH is associated with poor outcome, future studies are needed to determine if patients with low BG CBV should be excluded from IAT due to increased risk of ICH. .