The future of stroke care in Egypt: a recovery-oriented perspective from acute reperfusion to long-term rehabilitation

Stroke remains a major cause of mortality and long-term disability in Egypt. Over the past decade, Egypt has made important progress through the expansion of stroke units, intravenous thrombolysis, and endovascular thrombectomy services. However, many patients still arrive outside therapeutic windows, lack access to comprehensive stroke pathways, or experience persistent neurological, cognitive, language, and psychosocial disability after the acute phase. This Perspective argues that the next stage of stroke-care development in Egypt should be recovery-oriented rather than reperfusion-limited. Key priorities include equitable hub-and-spoke stroke networks, workforce development, emergency medical services pre-notification, streamlined imaging pathways, expanded multidisciplinary rehabilitation, digital follow-up, and national quality-monitoring systems. Because ischemic stroke involves excitotoxicity, oxidative stress, inflammation, blood-brain barrier disruption, impaired neuroplasticity, and network-level reorganization, adjunctive multimodal pharmacological strategies may complement reperfusion and rehabilitation in selected patients. Cerebrolysin is discussed as one example of an adjunctive neurorecovery therapy. A coordinated national strategy that integrates acute treatment, rehabilitation, quality improvement, and evidence-based recovery support may help reduce post-stroke disability and improve long-term outcomes for stroke survivors in Egypt.