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Scope of Application
This guideline is intended for physicians working in emergency departments (EDs).
Inclusion Criteria
This guideline is intended for adult patients 18 years and older presenting to the ED with acute ischemic stroke.
Exclusion Criteria
This guideline is not intended to be used for pediatric patients or pregnant patients.
Recommendations offered in this policy are not intended to represent the only diagnostic and management options that the emergency physician should consider. ACEP recognizes the importance of the individual physician’s judgment and patient preferences.
In adult patients with a suspected acute ischemic stroke, can a clinical decision instrument be used to identify patients who have an large vessel occlusion (LVO) on computed tomography angiography (CTA) or magnetic resonance angiography (MRA)?
None specified.
None specified.
In adult patients with suspected stroke, either the Los Angeles Motor Scale (LAMS) or Rapid Arterial Occlusion Evaluation Scale (RACE) may be used to identify patients with increased likelihood of an LVO.
None specified.
None specified.
In adult patients with suspected stroke, either the Los Angeles Motor Scale (LAMS) or Rapid Arterial Occlusion Evaluation Scale (RACE) may be used to identify patients with increased likelihood of an LVO.
In adult patients with a suspected acute ischemic stroke, does the addition of perfusion imaging to a CTA or MRA identify patients more likely to benefit from thrombectomy?
None specified.
None specified.
Obtain CTP or MR-based diffusion/perfusion imaging in patients with acute ischemic stroke because of LVO, especially if the time the patient was last known normal was between 6 and 24 hours before arrival to the ED.
None specified.
None specified.
Obtain CTP or MR-based diffusion/perfusion imaging in patients with acute ischemic stroke because of LVO, especially if the time the patient was last known normal was between 6 and 24 hours before arrival to the ED.
In adult patients with a suspected acute ischemic stroke qualifying for intravenous thrombolysis, is tenecteplase safe and effective compared with alteplase?
None specified.
Use either tenecteplase or alteplase in patients with acute ischemic stroke who qualify for thrombolysis.*
*For tenecteplase, use 0.25 mg/kg maximum dose 25 mg bolus; for alteplase, use 0.9 mg/kg maximum dose 90 mg with 10% given as a bolus and the remaining as an infusion over 60 minutes.
None specified.
None specified.
Use either tenecteplase or alteplase in patients with acute ischemic stroke who qualify for thrombolysis.*
*For tenecteplase, use 0.25 mg/kg maximum dose 25 mg bolus; for alteplase, use 0.9 mg/kg maximum dose 90 mg with 10% given as a bolus and the remaining as an infusion over 60 minutes.
None specified.
In adult patients who present with acute vertigo with possible stroke, is there a history or physical examination findings (eg, HINTS examination) that can risk stratify for acute ischemic stroke?
None specified.
None specified.
In addition to a standard comprehensive history and physical examination, physicians may use specific findings such as ABCD2 score, ocular motor examination, presence of additional neurologic deficits, and HINTS to risk stratify patients with a possible stroke.
Before employing a maneuver such as HINTS, physicians should have sufficient education to perform the technique (Consensus recommendation).
None specified.
None specified.
In addition to a standard comprehensive history and physical examination, physicians may use specific findings such as ABCD2 score, ocular motor examination, presence of additional neurologic deficits, and HINTS to risk stratify patients with a possible stroke.
Before employing a maneuver such as HINTS, physicians should have sufficient education to perform the technique (Consensus recommendation).
