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  • Preferred term: Stroke (CVA is like saying heart attack instead of STEMI)
  • Sudden onset, focal (usually one-sided) neurologic deficits: weakness, sensory loss, vision loss, ataxia/unsteadiness, vertigo, double vision, facial droop, dysarthria, aphasia

  • Differential:

    • stroke (ischemic or hemorrhagic)

    • seizure or post-ictal paralysis

    • headache phenomena (complex migraine)

    • cervical spinal cord lesions, though these more commonly cause bilateral symptoms

  • Stroke-like symptoms can also develop as recrudescence – previous stroke or brain lesion symptoms worsening with systemic toxic/metabolic/infectious processes or hypotension


-Critical decision-making information: last known normal (LKN), time symptoms first observed, anticoagulation status, recent surgeries, history of bleeding (severe GIB or ICH), recent medications, platelet count, and baseline neuro exam

  • If symptoms developed with LKN within 24 hours -> stroke alert!

  • If > 24 hours, can request Neuroalert Instead

    • VUMC: call 11111 and tell the operator stroke alert and current patient location

    • NAVA: call an RRT and stat page 835-5137, include in the page 911 at the end of the call back number to signal it is a stroke alert

  • Stat head CTP (order CTH/CTA) for consideration of tPA or endovascular therapy

    • If renal function is abnormal, discuss with neurology

    • Generally, go for CTA if the patient is a thrombectomy candidate (within 24 hrs of onset)

    • MRI/MRA is an option but takes longer (MRAs are also better with Gadolinium)

    • Neurology service should be leading this portion


  • Blood pressure goals

    • Ischemic stroke:

      • In general aim for SBP <220

      • Patients with intracranial atherosclerosis may require higher BP to maintain perfusion

    • Hemorrhagic stroke:

      • SBP < 140 (BP management is key)

      • These pts are managed in Neuro ICU

      • Reverse coagulopathies and keep platelets >100,000

Last update: 2022-06-23 16:38:32