A Neuro Reflection

Abstract

7 As mortality rates decline, the global burden of neurological disease is on the rise. Stroke affects 15 million people worldwide each year, contributing to 5 million deaths and another 5 million left with permanent disability (Vos et al., 2017). By 2050, the rate of dementia is expected to triple to 115 million worldwide (Prince et al ., 2013). Over the last twenty years, we have seen dramatic advances in the treatment of neurological disease. The National Institute of Neurological Disease (NINDs) trial that tested t-PA opened the door for successful treatment of acute stroke reducing death and disability (Koroshtez, 1996). In 2015, the results of five trials that evaluated endovascular treatments showed the profound benefit of early removal of thrombus in anterior circulation strokes (Goyal et al., 2016). Lessons from Finland taught us to reorganize our care, bypassing the red tape of “checking in patients” to adopt a “door to CT” approach that substantially reduced “door to needle” times and improved outcome (Lindsberg et al., 2006). In developed countries, medical progress has promoted the growth of specialized care units and tailored treatment for stroke, traumatic brain injury, dementia and Parkinson’s disease. These advances have opened the door for dedicated nursing training with certification programs like the Neuro Criticalcare Society’s Emergency Neuro Life Support (ENLS) aimed at improving care in the first critical hour after any neurological emergency. However, all of these advances come at a cost.