Telemedicine for Acute Neurological DiseaseTo Boldly Go Where No One Has Beamed Before

Matthews Gwynn, MDAcuteCare Telemedicine

Stroke Facts

• The 4th leading cause of death in the United States

• The #1 cause of adult disability in the United States

• 795,000 Americans suffer strokes each year• 87% of strokes are ischemic, 13% are

hemorrhagic• 134,000 deaths each year• 2,000,000 brain cells die every MINUTE

during stroke • Women are TWICE as likely to die from

stroke than breast cancer

• 6,400,000 stroke survivors (2% of U.S.)Connect to Quality 2

“Connect to Quality”

Telestroke: Scientific Validation

• Audio/Video telemedicine evaluation of an acute stroke patient leads to better decision-making and safety than telephone only consultations

• The NIH Stroke Scale (NIHSS) via telestroke consult is reliable

• Neurologists can reliably interpret brain CT images to confirm the diagnosis of acute ischemic stroke and establishing eligibility for IV-tPA

• IV-tPA can be administered safely through telemedicine and with outcomes comparable to those observed in patients being treated at tertiary care centers

• Telestroke networks have been proven cost effective

Case of Acute Stroke

• 46 yo woman developed dysarthria, right hemiplegia about 8:00 AM

• Quickly presented to Dale Medical Center• Teleneurologist responded 2 minutes after

receiving call and performed consultation immediately NIHSS=8

Connect through remote presence

Activase given at 9:10 AM after normal CT scan confirmed, and patient then transferred to Southeast Alabama Medical Center

MRA of Brain--Left M1 stenosis

Discharged 4 days later with only mild expressive aphasia

Stroke Mimic• 57 yo man developed lower extremity

numbness and weakness 2 days before presentation to local ER in Tennessee. Upper extremities, bowel and bladder normal.

• URI 2 weeks beforehand• NE showed hyporeflexia with assistance

from PA on site• BLE 4/5 weakness, especially proximally• Diminished light touch and pain sensation

from T12 on trunk down• Able stand only with assistance

DIAGNOSIS?

“Connect to Quality”

Sampling of Client HospitalsGeorgia

Alabama

Tennessee

South Carolina

Florida

ArizonaPending

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* In partnership with Eagle Physician Group

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Thank You