Acute Stroke

Document the last-known-well time, obtain a focused neurologic examination including standardized severity assessment, establish glucose and vital signs, and immediately determine whether the presentation represents ischemic stroke, intracerebral hemorrhage, or a mimic. Acute ischemic stroke reflects critical reduction in cerebral blood flow from arterial stenosis or occlusion; treatment selection therefore depends on timing, clinical deficit, vascular anatomy, and brain imaging. JAMA+1JAMAAcute Stroke Intervention: A Systematic ReviewBMJIschemic stroke - Symptoms, diagnosis and treatment | BMJ Best Practice US

Operational performance matters: current American Heart Association/American Stroke Association guidance addresses early management across the acute stroke continuum, and mobile stroke units can accelerate recognition and treatment of thrombolytic-eligible ischemic stroke. AHA Journals+1AHA Journals2026 Acute Ischemic Stroke GuidelinesAHA Journals2026 Guideline for the Early Management of Patients With ... Hospitals should use a protocol that permits noncontrast brain imaging, vascular imaging when large-vessel occlusion is suspected, laboratory testing, treatment eligibility review, and neurovascular consultation to proceed in parallel rather than sequentially. JAMA+1JAMAManagement of Patients With Acute Ischemic StrokeAHA Journals2026 Guideline for the Early Management of Patients With ...

Intravenous thrombolysis remains an early reperfusion strategy for eligible acute ischemic stroke. The supplied sources identify a conventional treatment window of less than 4.5 hours and describe evidence that tenecteplase 0.25 mg/kg as an intravenous push was noninferior to standard-dose recombinant tissue plasminogen activator in that time window; this statement derives from a Chinese guideline and should not be interpreted as a complete U.S. dosing or eligibility protocol. BMJBMJChinese Stroke Association guidelines for clinical ... The 2026 AHA/ASA guideline is the current U.S. early-management reference, but the available search content does not provide its detailed thrombolytic agent-selection, dosing, exclusion, or imaging criteria. AHA Journals+1AHA Journals2026 Acute Ischemic Stroke GuidelinesAHA Journals2026 Guideline for the Early Management of Patients With ...

For large-vessel occlusion, mechanical thrombectomy plus best medical management, including intravenous thrombolysis whenever indicated, improves functional outcome within 6 hours of symptom onset. Moderate-quality evidence also supports thrombectomy plus best medical management from 6 to 24 hours in patients meeting eligibility criteria used in published randomized trials. BMJBMJEuropean Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke | Journal of NeuroInterventional Surgery Late-window care is therefore an imaging- and trial-eligibility decision, not a reason to deny evaluation solely because presentation exceeds the conventional thrombolysis window. BMJ+1BMJEuropean Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke | Journal of NeuroInterventional SurgeryBMJChinese Stroke Association guidelines for clinical ...

During thrombectomy, avoid excessive blood pressure reductions. General anesthesia may be used when necessary, but patients receiving general anesthesia, conscious sedation, or local anesthesia require close vital-sign monitoring. BMJBMJEuropean Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke | Journal of NeuroInterventional Surgery Transfer decisions should prioritize rapid access to an endovascular-capable center when a potentially eligible large-vessel occlusion is identified. BMJBMJEuropean Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke | Journal of NeuroInterventional Surgery

For acute ischemic stroke patients undergoing intravenous thrombolysis, contemporary guideline comparisons report a target below 185/110 mm Hg before treatment and below 180/105 mm Hg for the first 24 hours afterward. NatureNatureBlood pressure management in stroke: comparative review of the 2025 AHA/ACC/AANP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM, 2024 ESC, 2023 ESH, and 2025 JSH guidelines | Hypertension Research These thresholds are specifically tied to reperfusion care; the available sources do not support a universal acute blood pressure target for ischemic stroke patients who are not receiving reperfusion therapy.

In patients undergoing thrombectomy, avoid excessive blood pressure drops and monitor vital signs regardless of whether general anesthesia, conscious sedation, or local anesthesia is used. BMJBMJEuropean Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischemic Stroke | Journal of NeuroInterventional Surgery Acute care should also include active surveillance for complications that alter neurologic trajectory and rehabilitation readiness, including dysphagia, immobility-related complications, bowel and bladder dysfunction, respiratory complications, pressure injury, and venous thromboembolism risk. acpjournals+1acpjournalsThe Management of Stroke Rehabilitation: A Synopsis ...ScienceDirectStroke Rehabilitation - an overview

Intracerebral hemorrhage may require immediate intensive care admission; otherwise, admission to an acute stroke unit is recommended as soon as possible. BMJBMJAcute intracerebral haemorrhage: diagnosis and management | Practical Neurology Raised intracranial pressure can result from hematoma mass effect, perihematomal edema, or hydrocephalus. BMJBMJAcute intracerebral haemorrhage: diagnosis and management | Practical Neurology Patients with GCS below 9, clinical evidence of herniation, or hydrocephalus warrant intensive intracranial pressure monitoring. BMJBMJAcute intracerebral haemorrhage: diagnosis and management | Practical Neurology

Supportive measures used for raised intracranial pressure in other settings may be considered, including head-of-bed elevation to 30 degrees, analgesia, mild sedation, and mannitol or hypertonic saline selected in light of cardiac and renal comorbidity; the source emphasizes limited direct evidence for these measures in ICH. BMJBMJAcute intracerebral haemorrhage: diagnosis and management | Practical Neurology Corticosteroids should not be used to lower intracranial pressure in ICH because they may cause more harm than benefit. BMJBMJAcute intracerebral haemorrhage: diagnosis and management | Practical Neurology

Avoid early limitation of care based solely on pessimistic assumptions. The ICH literature warns that therapeutic nihilism and early comfort-focused ceilings of care occur more often than in ischemic stroke and can influence outcome. BMJBMJAcute intracerebral haemorrhage: diagnosis and management | Practical Neurology Reassess prognosis after initial stabilization and communicate uncertainty explicitly.

Stroke rehabilitation begins once the diagnosis is established. In the acute phase, priorities include mobilization as tolerated, resumption of self-care, prevention of recurrent stroke and medical complications, and support for patients and families. ScienceDirectScienceDirectStroke Rehabilitation - an overview U.S. rehabilitation guidance emphasizes timing and approach, motor therapy, dysphagia, and cognitive, speech, and sensory deficits. acpjournals+1acpjournalsThe Management of Stroke Rehabilitation: A Synopsis ...acpjournalsStroke Rehabilitation: Synopsis of the 2024 U.S. ...

Use an interdisciplinary assessment to determine rehabilitation needs and destination. The available sources do not provide validated disposition thresholds, medication regimens for secondary prevention, or detailed post-stroke antithrombotic strategies; these should be determined by stroke subtype and current U.S. prevention guidance. BMJ+1BMJHemorrhagic stroke - Symptoms, diagnosis and treatment | BMJ Best Practice USacpjournalsStroke Rehabilitation: Synopsis of the 2024 U.S. ...