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Remote consultations lead to quicker treatment, better outcomes for stroke patients

Neurologist Robert Taylor, M.D., uses telemedicine technology to consult with other doctors about whether a stroke patient might benefit from thrombolytic therapy. (Photo: Richard Anderson)

Adnan Qureshi, M.D., knows the harm and sorrow that a stroke can leave behind. His mother died of a hemorrhagic stroke when she was 39 years old.

Her death fueled Qureshi’s determination to improve treatment for stroke patients. Today Qureshi, a professor in the University of Minnesota Medical School’s Department of Neurology, heads the University-affiliated Stroke Center. The center is a national leader in advancing clinical care and cross disciplinary research on stroke.

Strokes injure the brain in two ways: when a clot blocks the flow of blood, or when a blood vessel bursts. In either scenario, rapid identification of the problem and quick treatment can allow the patient to recover with little permanent damage. But if too much time passes, the outcome can be far worse.

In many parts of the state where comprehensive stroke care is not readily available, access to stroke experts can mean the difference between life and death.

Stroke specialist Adnan Qureshi, M.D., envisions a day when stroke diagnosis can start in an ambulance--shaving off important minutes before treatment begins. (Photo: Richard Anderson)

That’s why one of the Stroke Center’s many programs is focused on giving advice to physicians and helping to remotely diagnose patients during the crucial early minutes of a stroke. Emergency department doctors who call the center’s all-day, every-day physician hotline can lead patients into recovery when debilitation or death might otherwise result.

“The most common question from E.R. doctors is whether to give thrombolytic therapy,” which dissolves the blood clots that produce many strokes and can help to restore blood flow before disabling brain damage occurs, says Robert Taylor, M.D., an assistant professor in the University’s Departments of Neurology, Neurosurgery, and Radiology. But the medication also carries a risk of causing serious bleeding in the brain.

In crucial situations like these, Taylor says, the Stroke Center’s consulting physicians can recommend whether they think the patient will benefit from thrombolytic therapy.

Taylor believes the hotline is especially valuable for emergency department doctors at small hospitals, some of whom are family practice physicians with limited experience with stroke patients during the early hours of treatment.

“They feel more comfortable getting this kind of consultation because of the theoretical risks of the treatment,” Taylor says.

Physicians at Wadena Medical Center in Wadena, Minnesota, have an even greater level of access to the Stroke Center. Using a telemedicine video link, patients and their doctors in Wadena are connected directly with Stroke Center doctors. The Stroke Center consultant can lead patients through a neurological exam that allows doctors to evaluate the patient’s symptoms and responses based on the National Institutes of Health’s Stroke Scale, which leads to an assessment of the stroke and treatments if applicable. The Stroke Center is looking for funding to expand the use of this telemedicine technology to other medical centers around the state.

In the future, Qureshi believes that more hospitals in Minnesota will be able to give stroke patients the care they need.

“We’re emphasizing making many hospitals stroke-ready, which means enabling them to stabilize patients, monitor them, make the diagnosis of a stroke, and get brain imaging that confirms the diagnosis,” he says.

He also hopes that emergency medical services (EMS) crews, such as those working in ambulances, one day may be able to help get that process started—even before patients arrive at the hospital. He predicts that EMS personnel equipped with CT scanners in their vehicles will be trained to offer early stroke diagnosis, shaving off important minutes before the start of treatment.

“In the future, I foresee a broader access to an ever-higher standard of care,” Qureshi says. “We must recognize that if these services are not reaching every person with a stroke in this country, the benefits of new therapies will be definitely limited. We need to keep working on the way stroke care is organized along with improving our interventional treatments.”

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