Stroke: Inpatient Management

Suspected Acute Ischemic Stroke/TIA

Initial Evaluation

• History and Physical
• Blood tests (CBC, Plt, ESR, PT, PTT, Glucose, Chem-7, CPK, LFT, Optional Hypercoagulation Panel)
• ECG, Chest X-ray, EEG, LP, Toxicology screen (if appropriate)
• CT or MRI brain; consider CTA/MRA or carotid ultrasound TCD to evaluate large cerebral vessel patency
• Consider advanced brain imaging, including CT or MR angiography, CT or MR perfusion, CT or MR venography, carotid duplex, transcranial Doppler ultrasound, and PET imaging, in order to better understand stroke mechanism, pathophysiology, and refine therapeutic decision-making
• Consider admission to Neuro-critical care

Acute Ischemic Stroke

(ALL STROKES < 12 hrs after symptom onset)

• If < 3 hrs and no exclusion, consider
  iv t-PA
• Strokes up to 24 hrs after onset may be eligible for thrombolysis and/or neuroprotective trials

Further Management Depends on Presumed Pathophysiological Dx

• Causative Classification System for Ischemic Stroke (CCS)