Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA) July 2008

 Face - weakness?  Arm - weakness?  Speech - problems?  Test – Time to call 999  Exclude Hypoglycaemia as cause  ROSIER score in A+E

Assess swallow Early mobilisationGive aspirin 300mg Screen for malnutrition Admit to stroke unit Thrombolysis Immediate imaging Imaging asap Acute stroke confirmed

 Perform immediately if  Indications for thrombolysis or early anticoagulation treatment  On anticoagulant treatment  A known bleeding tendency  Depressed GCS  Unexplained progressive or fluctuating symptoms  Papilloedema, neck stiffness or fever  Severe headache at onset of symptoms  Otherwise perform asap

 Exclude intracranial haemorrhage  Should be given within 3 hours of symptom onset  Access to imaging and re-imaging  Should be administered within a stroke service  Consider BP reduction <185/110 in people who are candidates for thrombolysis

 Assess swallow on admission prior to administration of food, fluids or oral medications  Screen for malnutrition using validated tool - MUST  Consider NG tube feeding within 24 hours

 Encourage and support sitting up asap  Mobilise as soon as possible

 300mg aspirin asap within 24 hours  Continue aspirin for 2 weeks after stroke and then initiate long-term antithrombotic treatment  Do not start statin treatment immediately after an acute stroke  Continue statin treatment in those who are already taking statins

 Start daily aspirin 300mg immediately  Introduce measures for secondary prevention once diagnosis is confirmed  Assess risk of subsequent stroke – ABCD2

High risk of stroke: ABCD2 4 or more Crescendo TIA Specialist assessment within 24 hrs If vascular territory or pathology uncertain for urgent brain imaging Lower risk of stroke: ABCD2<3 1 week after symptoms resolved Specialist assessment within 1 week If vascular territory or pathology uncertain refer for brain imaging