Stroke: Subacute phase

Initial Management

• History and Physical
• Blood tests (CBC, Plt, ESR, PT, PTT, Glucose, Chem-7, CPK, LFT, Optional Hypercoagulation Panel)
• ECG and Chest X-ray
• CT or MRI brain; consider CTA/MRA or carotid ultrasound TCD to evaluate large cerebral vessel patency

Presumed Pathophysiological Dx

If < 12hrs from symptom onset, page Acute Stroke Team beeper #34282

Acute Ischemic Stroke

(ALL STROKES < 12 hrs after symptom onset)

• If < 3 hrs and no CT exclusion, consider iv t-PA
• If < 6 hrs in carotid territory or < 12 hrs in basilar territory, no CT exclusion, and CTA evidence of large vessel occlusion, consider IA thrombolysis
• Strokes up to 36 hrs after onset may be eligible for neuroprotective trials

Confirm the presumed pathophysiologic diagnosis with the following tests/procedures

• Evaluate cerebrovascular pathology with Carotid Ultrasound, TCD, CTA, Perfusion MR/MRA of Conventional Transfemoral Angiography
• consider cardiac echo (see Cardiac echo utilization for stroke/TIA)
• Consider IV Heparin in non-lacunar or non-infectious stroke
• Consider admission to Stroke Unit