Neurologic emergencies in resource-limited settings: a review of stroke care considerations

ABSTRACT

Background: The current guidelines and evidence supporting acute stroke management have limitations in resource austere environments despite being a leading cause of death worldwide. Developing countries face a rapidly increasing and disproportionate burden of cerebrovascular disease yet differences in setting and resource limitations bring challenges that have a major influence in management options - especially with routine imaging and interventional considerations. In addition; general awareness; diagnosis and management of stroke remain poor.Objectives:To outline current acute stroke management and critical interventions that should be integrated into current practice while highlighting resource-limited care considerations.Methods:A systematic search of Ovid MEDLINE and reference lists of the literature on stroke; guidelines; and acute stroke management including care considerations in resource-limited settings was conducted through March 2014. Recommendations:Within emergency medicine; emphasis should be placed on establishing a robust stroke assessment and care process that is resource appropriate and scalable. Adherence as resources allow to current stroke care guidelines including acute management; stroke center coordination; palliation and resource allocation may improve outcomes. Further research related to resource-limited management is essential. Risk reduction through population-based interventions and early recognition may help to reduce the burden of disease