COVID-19 and the Stroke Patient

U Republici Hrvatskoj proglašena je opasnost od epidemije COVID-19. Zdravstveni sustav, zdravstveni radnici i resursi su pri tome usmjereni na borbu protiv COVID-19. Formiraju se ustanove kao respiracijski centri te dodatni kapaciteti za zbrinjavanje oboljelih od COVID-19, a odvajaju se ustanove u kojima se zbrinjavaju bolesnici s akutnim neurološkim bolestima i stanjima, kao npr. s moždanim udarom. Za sada je nepoznat učinak infekcije COVID-19 na nastanak moždanog udara, ali očekuje se teža prezentacija bolesti. Iako se očekuje da će osobe zahvaćene zaraznim bolestima kao COVID-19 biti izložene povećanom riziku od ishemijskoga i hemoragičnoga moždanog udara, u hitnim službama diljem svijeta neočekivano se registrira smanjenje broja oboljelih od moždanog udara. Pretpostavlja se da bolesnici s blažim oblicima ili tranzitornim ishemijskim atakom ostaju kod kuće jer se od njih tako traži, da ograniče posjete hitnim službama i minimiziraju putovanja. Također, bolesnicima je prioritet izbjegavanje zaraze te najčešće ostaju kod kuće. Organizacija službe u Republici Hrvatskoj usmjerena je na aktivno liječenje moždanog udara u sveobuhvatnim centrima za liječenje moždanog udara prema definiranim protokolima, neovisno o statusu infekcije COVID-19. Započinje se sekundarna prevencija moždanog udara, a tendencija je usmjeravanje bolesnika na rehabilitaciju u svrhu smanjenja invalidnosti. Organizacija službe trebala bi omogućavati kontrolne posjete bolesnika liječniku, bez kontakta licem u lice, a mogu se odvijati preko telefona ili telemedicine, za što je neophodna informatička podrška. Na taj bi se način zaštitili bolesnici od zaraze i provjerilo pridržavaju li se mjera sekundarne prevencije.The Republic of Croatia has declared a risk of COVID-19 outbreaks throughout the country. The Croatian health system, healthcare professionals and resources are thus focused on the fight against the virus. Establishments and additional facilities are being set up as respiratory centers for the care of COVID-19 patients, as well as other locations to treat patients with acute neurological diseases and conditions such as stroke. The effects of COVID-19 infection on stroke is currently unknown, but more severe disease presentation is expected. Although people affected by infectious diseases such as COVID-19 are expected to be at increased risk of ischemic and hemorrhagic stroke, there is an unexpected decrease in the number of stroke patients in emergency services worldwide. It is presumed that patients with milder symptoms or transient ischemic attack are at home because they are required to do so, as well as limit emergency room visits and minimize travel. The patients’ own priority is to avoid contagion, and so they most often stay at home. The organization of the service in the Republic of Croatia is focused on the active treatment of stroke patients in comprehensive stroke centers according to defined protocols, regardless of the status of the COVID-19 infection. Secondary stroke prevention begins, and the tendency is to direct patients to rehabilitation in order to reduce disability. The organization of the service should allow for non-face-to-face patient control visits, which may take place over the phone or via telemedicine - which requires IT support. This would protect patients from infection and check that they comply with the control of risk factors