First steps

• Activate stroke pathway, note last-known-well time
• NIHSS, glucose, ABCDE
• Non-contrast CT head within 25 min

Key investigations

• NCCT ± CTA/CTP
• Glucose, INR, platelets, RFT
• ECG (AF), troponin

Differentials

• Ischemic stroke
• Haemorrhagic stroke
• Stroke mimic (hypoglycemia, seizure, migraine, conversion)

Initial management

• BP <185/110 before thrombolysis; otherwise permissive
• IV alteplase 0.9 mg/kg if eligible within 4.5 h
• Thrombectomy assessment if large-vessel occlusion within 24 h
• Antiplatelet (aspirin 300 mg) at 24 h post-thrombolysis

Referral

• Stroke unit
• Neurology / Interventional

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