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On September 16, 2024, Professor Christoph Kosinski, chief of neurology at Rhein-Maas-Kliniken, delivered a great lecture on “Stroke Workup and Etiology”. We are excited that more than 30 participants where eager to explore the causes of stroke and how to prevent future stroke events.
Dr. Kosinski began the lecture with a critical question: “Why put a patient in a stroke unit?”. Dr. Kosinski highlighted that stroke units significantly improve patient outcomes and prevent death. He emphasized that stroke units focus on three critical components: Early rehabilitation, prevention of complications and prevention of recurrent stroke. These three pillars form the backbone of effective stroke care, optimizing patient recovery and reducing the risk of further strokes.
Understanding the underlying cause of a stroke is essential for determining the most
appropriate treatment and preventive measures. Dr. Kosinski introduced the TOAST
classification, a system that categorizes stroke etiologies into five distinct groups:
1. Macroangiopathy: stenosis of intracranial or extracranial arteries due to
atherosclerosis. Diagnosis is typically done through duplex sonography. Secondary
prevention strategies include lifestyle changes, medications and vascular surgery.
2. Cardioembolism: Common in atrial fibrillation and managed with anticoagulants.
3. Small Vessel Disease: Tthickening of capillary walls due to atherosclerosis, amyloid
plaques, or inherited diseases. Prevention through reduction of risk factors.
4. Other Determined Etiologies: Includes rare causes like vasculitis, moya-moya
disease, thrombophilia or carotid dissection.
5. Undetermined Etiology: Strokes with unclear or multiple causes.
The causes of stroke can vary significantly based on the patient’s age. Patients over 50
often suffer from atrial fibrillation, atherosclerosis or microangiopathy, while in younger
patients rare causes like dissection or patent foramen ovale are more frequent. This
means that different diagnostic tools become more relevant depending on the patient in
front of you. However, the two most important diagnostic tools in stroke etiology are ECG
and duplex sonography. Dr. Kosinski also recommended the use of checklists to ensure
that all aspects of stroke identification and treatment are considered.
Prevention is a cornerstone of stroke management, and Dr. Kosinski stressed the
importance of secondary prevention measures. Secondary prevention includes vascular
surgery for carotid stenosis and oral anticoagulation for atrial fibrillation, along with
lifestyle modifications like managing blood pressure and quitting smoking.
The session concluded with a lively discussion on stroke treatment strategies in Nepal.
Additionally, many participants had insightful questions, enriching the overall learning
experience for everyone involved. We extend our thanks to Dr. Christoph Kosinski and all
participants for another fantastic lecture.
Mark your calendars for the next lecture on September 26, 2024, where Dr. Pradesh
Ghimire will cover “Introduction to Neuroimaging for Acute Stroke.”