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Lancet Stroke Series

The Lancet recently published a three-part Series in advance of the World Stroke Congress, which covers ischaemic stroke, intracerebral haemorrhage, and implications for global stroke prevention and management, and features Emerging Leaders Faculty Member Craig Anderson as well as 2018 Emerging Leader Dorcas Gandhi.

Stroke is the second leading cause of death globally, resulting in more than 5 million deaths worldwide every year. It is also a leading cause of disability, with many individuals who survive a stroke left with long-term disability. The landscape for stroke treatment has changed hugely in recent years, and many patients with acute ischaemic stroke now benefit from treatments such as intravenous alteplase and endovascular thrombectomy. This Series of papers discusses recent advances in the diagnosis and management of the two major stroke subtypes—ischaemic stroke and haemorrhagic stroke—as well as strategies to reduce the risk of stroke, particularly in low-income and middle-income countries where the burden of stroke is the greatest.

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Listen to Emerging Leaders faculty member and stroke research front runner Craig Anderson discuss this new series with Helen Frankish, Executive Director of the Lancet. Download audio

Read Craig Anderson: a front runner in stroke research

 

The series features an article titled Intracerebral haemorrhage: current approaches to acute management, authored by, among others, Emerging Leaders faculty member Craig Anderson.

Summary

Acute spontaneous intracerebral haemorrhage is a life-threatening illness of global importance, with a poor prognosis and few proven treatments. As a heterogeneous disease, certain clinical and imaging features help identify the cause, prognosis, and how to manage the disease. Survival and recovery from intracerebral haemorrhage are related to the site, mass effect, and intracranial pressure from the underlying haematoma, and by subsequent cerebral oedema from perihaematomal neurotoxicity or inflammation and complications from prolonged neurological dysfunction. A moderate level of evidence supports there being beneficial effects of active management goals with avoidance of early palliative care orders, well-coordinated specialist stroke unit care, targeted neurointensive and surgical interventions, early control of elevated blood pressure, and rapid reversal of abnormal coagulation.

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The series also features a paper co-authored by one of our 2018 Emerging Leaders, Dorcas Gandhi, titled Prevention of stroke: a global perspective.

Summary

Along with the rising global burden of disability attributed to stroke, costs of stroke care are rising, providing the impetus to direct our research focus towards effective measures of stroke prevention. In this Series paper, we discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), and preventing the recurrence of disease (secondary prevention). Our focus includes global strategies and campaigns, and measurements of the effectiveness of worldwide preventive interventions, with an emphasis on low-income and middle-income countries. Our findings reveal that effective tobacco control, adequate nutrition, and development of healthy cities are important strategies for primordial prevention, whereas polypill strategies, use of mobile technology (mHealth), along with salt reduction and other dietary interventions, are effective in the primary prevention of stroke. An effective collaboration between various health-care sectors, government policies, and campaigns can successfully implement secondary prevention strategies, through surveillance and registries, such as the WHO’s non-communicable diseases programmes, across high-income and low-income countries.

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