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Palliative care is used by many people with non-cancer diseases. The palliative care requirements of individuals with neurologic and neurosurgical diseases are poorly understood. Overall stroke mortality has decreased as a result of improvements in acute stroke care, particularly in specialist facilities. If a patient with an acute ischemic stroke arrives to the hospital early enough, mechanisms should be in place to deliver tissue-type plasminogen activator within an hour of arrival, effectively tripling the patient's odds of future autonomy. Stroke palliative care is a critical component of high-quality stroke care and should be a focus of our investigation as well as internship and fellowship training.

Palliative care and stroke

After a stroke, palliative care demands are prevalent and significant, but there is little research on the specific nature of these requirements and the best techniques for identifying and managing them. The majority of the research on palliative care and stroke is on end-of-life care and dying, with a focus on symptomatic treatment for the dying and assistance for family members dealing with tough decisions and loss. In-patient charts and computerized data of patients with neurologic or neurosurgical diseases were evaluated. Cancer patients were not allowed to participate. According to one comprehensive survey, there is a significant information gap about the specialized palliative care needs of stroke patients, and "collaborative research involving practitioners in specialist palliative care and stroke communities" is needed [1].

Palliative care integration with primary and specialist care

Multiple members of the multidisciplinary care team perform palliative care. Because the role of palliative care has expanded and the popularity for early palliative care is growing across the bandwidth of chronic conditions, an approach has been developed that separates primary palliative care (skills that all clinicians should have) from specialized palliative care (provided by clinicians who are boarded in medicine and are trained in managing more challenging and complicated cases). Palliative care specialists provide an additional layer of support to patients, family caregivers, and physicians. They may be called upon to help, manage complex or refractory clinical signs or to assist with difficult family meetings; they may also be called upon to help with the repercussions of conflicting goals of care, transformation to end-of-life or hospice care, and bereavement support [2].

Special palliative care for severe stroke

Although palliative care is appropriate for all stroke patients and their families, it is especially important for individuals who have had a catastrophic stroke. The National Institute of Health Stroke Scale is one approach to characterize severe stroke because there is no negotiated criteria. Severe stroke, on the other hand, is described as a stroke that cannot be survived without intensive medical or surgical intervention, such as intubation and mechanical breathing or brain surgery, or necessitates long-term institutional care. Ischemic strokes, as well as intraparenchymal and subarachnoid hemorrhages, are included in this definition. Despite the significance of palliative care for individuals with symptomatic stroke, there is no guidance on best practises for implementing palliative care into the care of these patients who are considering withdrawing existence treatment, resulting in significant variation in care [3].

Formulating personal treatment objectives

An accurate diagnosis of patient preferences is critical for determining the most suitable, patient-centered treatment recommendations. Predicted future health states and related tradeoffs are valued differently by various persons. Because they ask crucial questions, notice key symptoms, and target specific syndromes, neurosurgeons are extremely adept medical detectives. As we implement primary palliative care into our practices, we must hone our storytelling skills so that we can extract not just objective data but also the patients' or their families' personal knowledge of the condition, as well as their aspirations and anxieties. The ability to engage genuinely with the patient and family, to listen empathize, and to suffer alongside them helps to build a courteous and cost effective collaboration between the surgical department, who are experts in diagnosing and treating the specific illness, and the patient and their family, who are experts on their own story, as well as their values, goals, and priorities [4,5].

Patients with severe stroke require early palliative care, which includes psychological support for the patient and caregiver, collective decision for preference-sensitive treatment decisions, setting patientcentered care objectives, and pain and symptom control. Early stroke palliative care should be integrated with life-saving and neurorestorative therapies and offered by stroke therapists, depending on the capabilities of the multidisciplinary palliative care team when these experts can provide further support for patients, family members, or doctors. To assure that all practitioners are skilled in fundamental palliative care abilities as well as adept in triaging recognized requirements to consultation specialists, vascular neurology fellowships should incorporate palliative care competences. Patients with a variety of neurologic and neurosurgical diseases require PM services. Understanding the demands would allow palliative care interventions to be tailored to these individuals.