Clinical acute stroke evaluation

This article outlines the evaluation and management of acute stroke patients in the emergency room and during the acute stroke period. Although a few neurologic and metabolic processes can mimic stroke, a stroke can often be diagnosed and localized from the history and examination. The availability of a treatment that must be given within 3 hours of symptom onset, tissue plasminogen activator (tPA), necessitates that the initial evaluation be streamlined. The assessment of the potential tPA candidate requires specific attention to bleeding risks. All stroke patients benefit from interventions to limit complications in the acute period although in the thrombolytic- treated patient, blood pressures are managed more aggressively to prevent intracranial hemorrhage.