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Stroke: Inpatient Management

The protocols and guidelines we use for the treatment of stroke in the subacute phase.

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Suspected Acute Ischemic Stroke/TIA

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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


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Hemorrhagic

SAH
ICH

Acute Ischemic Stroke

(ALL STROKES < 12 hrs after symptom onset)



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Stroke Mimic

Tumor
Migraine
Seizures
Demyelination

Further Management Depends on Presumed Pathophysiological Dx


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Ischemic Stroke



Embolic Stroke

Large Vessel Stroke

Lacunar Stroke

Stroke due to Other Mechanisms

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In the News

The MGH Neurology Department placed 4th in US News Neurology / NeuroSurgery rankings for 2014-15.

Educational Video

Still from the Stroke Evaluation simulation

This video simulation of an Emergency stroke evaluation illustrates the care of patients with acute stroke by the MGH Acute Stroke team.