Neurology  |  Stroke Pathway - Acute Stroke Pathway


Stroke Pathway - Acute Stroke Pathway

Quick Reference Acute Stroke pathway for use by Assessing Acute Medical Team

1. Suspected Stroke

2. If less than 4 hours from onset of symptoms refer thrombolysis pathway

3. For those outside of the thrombolysis window perform a Clinical Assessment

4. Perform IMMEDIATE CT head if ANY of the following:

  • Thrombolysis candidate
  • Anticoagulated
  • Reduced or deteriorating conscious level
  • SAH
  • Suspected neurosurgical diagnosis eg SDH or brain sepsis

5. Tests in ALL Patients:

  • 12-lead ECG
  • CBC, U&E, ESR, glucose, LFT, lipid profile
  • CT head within 24 hours (including weekends)

6. Test in SELECTED Patients:

  • TFTs if in AF
  • INR if on warfarin
  • Carotid Dopplers in anterior circulation strokes (good recovery or low disability)
  • CXR if smoking history or cardio-respiratory disease
  • Telemetry if ?PAF
  • ECHO, thrombolysis screen, vasculitis screen are usually reserved for young 'cryptogenic' stroke patients who should be assessed by a stroke specialist

7. Acute Treatment

  • Asprin only: 300mg/day - once CT head excludes haemorrhage (+/-PPI)
  • Ensure normal Sp02 and temperature
  • Treat hypo or hyperglycaemia
  • Do NOT prescribe thromboprophylaxis
  • Do not prescribe new statins within the first 48 hrs
  • Do not start new antihypertensives unless BP >220/120 (infract) or >180/100 (haemorrhage)
  • Do NOT prescribe anticoagulants (see full guideline for details) If any patient is already on antihypertensives and a statin, these should be continued unless the BP is low.

8. Refer all stroke patients to the Stroke Team (HIA)

Last updated : Tuesday, April 19, 2016
Next review date : Wednesday, April 19,2017

Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.