Stroke unit: A cardio-cerebral approach

Stroke units are special units where stroke patients receive, simultaneousl y, medical and physical treatment. Compared to general neurological and med ical wards, stroke units show a significant reduction of short- and long-ti me mortality, and an improvement of long-term quality of life. Nevertheless , mortality in these units is still high (1-year mortality similar to 32% 5 -year mortality similar to 60%), and consequently, new approaches are neede d to control stroke parameters during the acute phase, with the goal to red uce mortality rates. The philosophy of our stroke unit in Fermo (Italy), is to establish a strong association between heart and brain care by approach ing each stroke patient as a cardiocerebral patient. In particular, we perf orm 12-lead Holter ECG monitoring, to prevent the vicious cycle affecting c orrect cerebral and cardiac functions, and to react to cardiac complication s, mostly arrhythmias, that can worsen cerebral damage. Holter ECG monitori ng allows a fast physiotherapeutic approach, a better evaluation of metabol ic parameters, and collectively, a better global evaluation of the patient during the acute phase of disease. In two years of activity, 80 patients th at were admitted to our stroke unit during 1998, and treated as cardio-cere bral patients, were followed-up. This combined treatment decreased the 1-year mortality rate by about 30%, i n comparison with the 22% mortality rate reported in the literature. These results confirm the validity of stroke units, as well as of our approach ba sed on cardio-cerebral control of each stroke patient.