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NICE Guidance: Stroke

NICE Guidance: Stroke. Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA) July 2008. Rapid recognition of symptoms and diagnosis. Face - weakness? Arm - weakness? Speech - problems? Test – Time to call 999 Exclude Hypoglycaemia as cause

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NICE Guidance: Stroke

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  1. NICE Guidance: Stroke Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA) July 2008

  2. Rapid recognition of symptoms and diagnosis • Face - weakness? • Arm - weakness? • Speech - problems? • Test – Time to call 999 • Exclude Hypoglycaemia as cause • ROSIER score in A+E

  3. Emergency treatment for people with acute stroke Acute stroke confirmed Immediate imaging Imaging asap Thrombolysis Admit to stroke unit Early mobilisation Give aspirin 300mg Assess swallow Screen for malnutrition

  4. Brain imaging • 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

  5. Thrombolysis with alteplase • 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

  6. Swallowing and Nutrition • 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

  7. Early mobilisation • Encourage and support sitting up asap • Mobilise as soon as possible

  8. Pharmaceutical management • 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

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

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

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