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

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