Sudden focal neurological deficit from interrupted cerebral perfusion lasting >24 h or with infarction on imaging.
Causes
- • Large-vessel atherosclerosis
- • Cardioembolic (AF)
- • Small-vessel (lacunar)
- • Dissection, vasculitis
Clinical features
- • FAST: Face, Arm, Speech, Time
- • Hemiparesis, dysphasia, neglect
- • Visual field deficit
Investigations
- • Urgent non-contrast CT head (exclude haemorrhage)
- • CTA for LVO
- • Glucose, ECG, bloods, lipids
- • MRI for posterior circulation if CT negative
Management
- • Thrombolysis with alteplase ≤4.5 h
- • Mechanical thrombectomy ≤6 h (selected ≤24 h)
- • Aspirin 300 mg after bleed excluded; switch to clopidogrel at 2 weeks
- • Statin, BP control (delayed), DVT prophylaxis (IPC initially)
- • Stroke unit, SALT swallow, MDT rehab
Complications
- • Haemorrhagic transformation
- • Cerebral oedema
- • Aspiration pneumonia
- • DVT/PE
Prevention
- • Manage AF (DOAC), BP, lipids, DM
- • Smoking cessation
Clinical pearls
- • ROSIER score for ED stroke recognition
- • Don't lower BP <220/120 in first 24 h unless thrombolysis
References
- • NICE NG128
- • AHA/ASA 2019
Related in WardRound
Educational — verify locally.
