Initial Evaluation

• Diagnosis: sudden onset, Neuro deficit
• Onset: Time last known normal (LKN)

Last Known Normal

• If < 4.5 hours, consider TPA
• If < 24 hours, may be intervention therapy candidate

If not TPA candidate

• Give Aspirin po 325 mg or suppository 300 mg

All stroke patient

• CT head to check for bleed
• Bed rest
• CTA if not contraindicated, may perform after tpa
• Heart monitoring, check for atrial fibrillation
• Check glucose stat, if high treat
• Permissive hypertension until neuro status stablized (see BP management)
• Deep vein thrombosis prophylaxis
• Check lipid in am
• Consider High intensity Statin: Lipitor 40-80 mg qd
• Urine drug screen
• Young female: pregnancy test

Medscae: acute stroke management

NIH Stroke Scale online form - Medscape

NIH Stroke Scale online form

NIH Stroke Scales Paper Form