The mobile stroke unit and management of acute stroke in rural settings

In patients with suspected acute stroke, immediate brain imaging, most frequently with computed tomography (CT), is essential to distinguish between an ischemic lesion and a hemorrhage. In ischemic stroke, timely treatment with intravenous tissue plasminogen activator or thrombectomy results in substantial clinical improvement. The treatment is time dependent with a 5% decrease in mortality for every 15-minute reduction in door-to-needle times. Although access to cranial CT scanners poses few problems in urban areas, this may be challenging in rural settings. The recent installation of portable scanners in ambulances (i.e., mobile stroke unit) facilitates rapid evaluation and treatment of patients with acute stroke. Although the emphasis is currently on the evaluation and management of acute stroke, the mobile stroke unit may be used in the management of other neurologic and neurosurgical emergencies.Portable CT technology continues to improve. Introduction of CT angiography and CT perfusion into mobile stroke units will allow for detection of major arterial occlusions in patients with acute stroke, allowing for diversion to specialized hospitals that offer thrombectomy services.