Αcute Stroke Unit (ASU)

Metropolitan General’s Acute Stroke Unit is one of the few organized and well-equipped Units throughout the country. It is an active member of the international network of SITS (Safe Implementation of Treatments in Stroke) which solely accepts centers which are certified, abide to high quality and safety standards, accommodate the required infrastructure, and are staffed by highly skilled medical and nursing personnel.

The Unit operates on a 24/7 basis and is staffed by extensively experienced and highly specialized neurologists and well-trained nursing practitioners who, in cooperation with physicians of related specialties (neurosurgeons, interventional radiologists, interventional cardiologists, intensivists, anesthesiologists), deliver prompt diagnosis and comprehensive and personalized treatment.

Stroke is a medical emergency requiring immediate management and timely presentation of the patient to the hospital.

"Time is brain"

Stroke management within less than 3-4 hours from symptoms onset is crucial to treatment effectiveness and complications reduction. A dominant expression within English medical literature is “time is brain”; it highlights the very short lifesaving time frame for the brain. It is estimated that about 2 million neurons are lost per minute of delay in obstruction management.

Metropolitan General’s Acute Stroke Unit applies all modern treatment methods adhering to the latest international guidelines, aiming at maximizing patient clinical benefit. At the same time, the excellently equipped Intensive Care Unit (ICU) accommodated in the Hospital, ensures the medical/nursing care required.

What is a stroke?

A stroke, or cerebrovascular accident (CVA), causes brain damage, and is either owed to disturbance in the blood supply to a particular brain area (ischemic stroke) or hemorrhage from a burst blood vessel (hemorrhagic stroke).

In particular, a stroke is the result of brain vessel obstruction, either due to clots formed in a narrowed artery (thrombosis) or a clot which was formed in another part of the body and travelled to the brain arteries through blood flow (embolism). The type, severity and symptoms restoration of a stroke depend on the extent of the hypoperfused area and its reperfusion time.

A stroke may occur due to cerebral aneurysm rupture or vascular malformation, or to small vessels rupture within the brain, and causes hemorrhage inside (intracerebral) or around the brain (subarachnoid).

According to the data of the World Stroke Organization:

One in six people in the world will suffer a stroke at some point in their life, regardless of age
Stroke is the 3rd leading cause of death after heart disease and cancer
Mortality within the first year after a stroke accounts to 30%, while 1/3 of the patients exhibit some form of impairment and require another person’s assistance
About 88% of strokes are characterized as ischemic
Stroke is considered a “feminine concern” as it affects 60% of the female population
Stroke is not a disease of the third age, given 20% of the patients are below the age of 55
Many patients, though they present to the hospital within 3 hours from symptoms onset, are not administered the applicable treatment due to the hospital’s poor infrastructure and inadequate staffing

Diagnosis and Treatment

A patient presenting to the Emergency Department at Metropolitan General with suspicion of a stroke, is rapidly evaluated for the establishment of stroke. Nurses with extensive experience on emergencies receive the patient and notify the Stroke Team. A specialized neurologist conducts the immediate clinical assessment of the patient and with the cooperation of highly experienced radiologists and the assistance of CT- and/or MRI-scans, the extent of the brain damage is determined.

The goal for the acute management of patients with stroke is to dissolve or remove the clot obstructing the brain vessel and the restoration of normal cerebral perfusion.

Within 3 hours from symptoms onset, a special thrombolytic agent is intravenously administered (Actilyse r-tPA) which, under specific circumstances, dissolves the clot and restores brain perfusion to normalcy. The safe use of the drug and the likelihood of favorable results for the patient are both determined with the observance of action protocols according to the AHA/ASA 2013-2015 guidelines.

Within 6 hours from symptoms onset, the clogged vessel is opened via mechanical thrombectomy. The method, combined with intravenous thrombolysis, is applied within 4.5 hours from symptoms onset in patients with severe stroke (NIHSS>6) due to large vessel occlusion - it is considered the only treatment option when contraindications in administering the thrombolytic agent are present or because of late patient arrival. Thrombectomy constitutes the latest treatment advance in acute stroke management because vessel opening is achieved in 70 - 80% of the cases.

How to identify stroke symptoms

Probable Stroke Recognition Test

(Modified Probable Stroke Recognition Test – Cincinnati Prehospital Stroke Scale)

You can EASILY recognize stroke symptoms by performing the following 3 steps:

Arms
Have the patient with the suspected stroke extend both arms, palms facing upwards and eyes closed
NORMAL: Both arms move the same or both arms do not move at all
ABNORMAL: One arm does not move and drifts down compared with the other
Face
Have the patient smile
NORMAL: Symmetry present, both sides of the face move equally
ABNORMAL: Asymmetric movement, one side of the face moves less or does not move at all, the mouth has dropped
Speech
Have the patient repeat a simple phrase, e.g. “I got back home from work”
NORMAL: Patient repeats clearly and correctly with no slurring
ABNORMAL: Patient does not repeat clearly and correctly, slurs words, uses wrong words, manifests dysarthria or is unable to verbally respond
Timely
If one of the above is abnormal, do not hesitate and contact a specialized Unit immediately.
If any ONE of these 3 signs is abnormal, the probability of a stroke is 72%
If MORE THAN ONE is abnormal, the probability of a stroke is >85%

Metropolitan General’s Acute Stroke Unit runs a 24-hour helpline, tel: +30 210 650 2700, staffed by highly skilled personnel to provide guidelines on the correct stroke symptoms recognition.

Contact Number: +30 210 650 2700