Challenges in the Management of Stroke in Intensive Care Units in Low- and Middle-Income Countries

Despite numerous advances in stroke care over the last decades, financial and structural barriers limit the effective incorporation of these therapies globally. The aim of this narrative review is to examine challenges and propose context-specific strategies to improve neurocritical stroke care in low-resource settings. Short-term treatment of severe strokes can be particularly challenging in low- and middle-income countries (LMIC) due to the inadequate infrastructure of intensive care units, with limited resources and lack of specialized training. For greater effectiveness of neurocritical care treatment of patients with stroke in LMIC, a broad and holistic approach is necessary, including developing clinical protocols adapted to local realities, ensuring the employment of cost-effective interventions and the financial sustainability of health systems. Innovative solutions with wearables and artificial intelligence are leading the way in improving clinical monitoring of patients in regions with limited resources. Continuous improvements are also possible through international collaborations and long-term investment in sustainable local health systems. Finally, addressing socioeconomic and cultural barriers and ensuring access and equity through strategic investments and policies that promote universal health coverage are essential steps in reducing the burden of stroke worldwide.