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Stroke

The Stroke Unit of the Universal Clinic “Oberig” is a medical establishment has all the necessary medical, diagnostic and professional resources to assist the patient with stroke at any stage of recovery –from diagnosis and acute intensive therapy to rehabilitation after stroke.

1. CORRECT AND FULL DIAGNOSIS IS A PREREQUISITE TO SUCCESSFUL TREATMENT

Why is it so important to do a work-up and make a correct diagnosis of stroke? First and foremost, it’s usually impossible to establish what exactly caused the brain injury with all its signs and symptoms without performing some tests. Clinical examination alone does not allow distinguishing brain infarction from intracerebral bleed, and most experienced physicians without brain scanning can make a wrong diagnosis, which may lead to an adverse outcome.

In acute brain disease the definitive diagnosis can be made only after brain imaging with a CT or an MRI. Timely diagnostics is crucial as emergent interventions (such as thrombolysis) can significantly reduce damage to the brain.

Stroke Center of the Universal Clinic ‘Oberig’ offers the full set of diagnostics that allows to confirm or rule out a stroke as well as to define its type and likely subtype (eg, atherothrombotic or cardioembolic brain infarction). The expedited work-up takes about 4 hours. It includes brain scanning (CT or MRI), imaging of brain vessels (CT-angiography or MR-angiography), EKG and Cardiac Echo, Neurological Exam and some blood tests. Based on the results, a Vascular Neurologist will provide his opinion and recommendations.

2. INTENSIVE CARE IN ACUTE STROKE

Acute stroke is an emergency, and a patient’s life will to a great extent depend on the steps taken or not taken over the first hours after the "vascular accident". The best option we can offer most stroke patients is admitting them to a Stroke Unit. Treatment in our Stroke Unit includes vital signs monitoring, blood pressure and respiration control, prevention and early detection of complications and early mobilization.

A stroke is often a strong stress to the body, aggravating all chronic diseases. For instance, if a patient had had diabetes and had been taking pills, after a stroke he/she may temporarily require insulin to control the diabetes. It’s important to review all the systems that can be involved as well as keep an eye on most common problems such as difficulty swallowing, deep vein thrombosis, pressure sores, urinary infections etc. It’s not enough to just bear in mind all potential problems, it’s necessary to transform knowledge into action and implement appropriate strategies.

Our Stroke Center has all the recourses needed for the Intensive Care in severe stroke, including Critical Care physicians and nurses, high-quality ventilators, various monitors and oxygen supplies. Our lab is working 24/7. All these in addition to access to all types of state-of-the-art investigations (brain, heart and vascular imaging, evoked potentials, electroencephalography, ultrasound etc.) allow us to reduce mortality to below 5% and to promote recovery.

Stroke Center at the Universal Clinic ‘Oberig’ strives to keep up with best international standards of stroke care and to stick to principles of best clinical practice. Accordingly, we do our best to start comprehensive rehabilitation as early as possible. For instance, we stick with the principle of early mobilization, and get most our patients out of bed as soon as they are clinically stable (usually on Day 2 or Day 3 after the onset of stroke). It’s never late to start with Rehabilitation, but the earlier it begins the better the result.

As concerning the medication after a stroke, we early start appropriate secondary prevention, which is prescribed according to the guidelines. After a brain infarction (ischemic stroke) optimal secondary prevention usually consists of a blood thinner, several blood pressure drugs and a statin. Unlike many other hospitals in Ukraine, we do not use drugs that have not been shown useful in clinical studies and are not approved in developed countries (neuroprotectants, antioxidants, vasodilators etc.). However, we do use drugs to prevent venous thromboses and to treat infections, depression, spasticity, acute or chronic pain, insomnia, cognitive decline.

If the best secondary prevention is prescribed and the patient is compliant with the treatment, recurrent stroke risk may be reduced by 70 to 80%. Recent follow-up of 300 patients admitted to our Stroke Center over the last three years showed that only four of them had developed a new stroke. Hence, appropriate medication after a stroke is essentially limited to optimal secondary prevention and treatment of certain symptoms. Many drugs routinely used to treat stroke in Ukraine (especially given in drips or shots) seem useless and may be harmful.

3. REHABILITATION AFTER STROKE

Massive stroke changes people causing the majority of patients to sufferfrom severedepression. People who are used to active lifestyles find it most challenging to adjust to new demands of ‘life after stroke’. As a result, some people become aggressive, irritable and unfair in their treatment of their loved ones. Like any other disease, stroke is a major challenge and nobody has the right to judge those unable to cope with it.

Following the best standards of practice in neurorehabilitation, the Stroke Center offers a multi-disciplinary approach incorporating physical, psychological and social rehabilitation. Treatment begins as early as in the first days after stroke and lasts continuously till maximal potential has been reached. The individualized rehabilitation program at the Stroke Center is carried out by the multi-disciplinary team (physical, occupational and speech therapists, neuropsychologists, specialists in physical agent modalities, etc.) in collaboration with the patient’s family, and in accordance with the patient’s needs.

The patient becomes an active participant in all treatments – from early verticalization and rigorous intervention to regain movement and speech – to mastering independence with self-care skills, emotional and psychological self-regulation. All interventions are aimed at increasing the self-esteem and quality of life of the patient and his family.

Each patient of the Stroke Center is in the immediate care of up to 5 specialists, including physicians and therapists. Patients receive from 3 to 5 hours of direct treatment towards achieving their goals and maximal recovery.

The Stroke Center of the Universal Clinic “Oberig” demonstrates that stroke is not a death sentence. If stroke happened to you or your loved ones, please remember that early hospitalization to the specialized Stroke Center greatly increases your chances for recovery. Do not delay calling the contact center of the Universal Clinic “Oberig”. Dial +38 (044) 390-03 03.

Please, remember that stroke demands a lot of courage from the patient, and much patience and love from his family.

Doctor of the department

Flomin Yuriy
Flomin Yuriy

Nevrologist
21 years of working experience
MD PhD
y.flomin@oberigclinic.com

Gulyaev Marina Vitalevna
Gulyaev Marina Vitalevna

Руководитель научно-орг. отдела
Инсультного центра
28 лет медицинского стажа

Асташкина Нина Владимировна
Асташкина Нина Владимировна

Врач анестезиолог-интенсивист Инсультного центра
17 лет медицинского стажа
категория высшая

Irina Gavryliv
Irina Gavryliv

Neurologist

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