Management of Acute Stroke 1

Presentation with focal neurological symptoms, <24 hours

Introduction

The sudden onset of focal neurological symptoms implies a transient ischaemic attack (TIA) or stroke. A diagnostic distinction can sometimes be made between patients with suspected TIA or stroke. For management purposes, however, patients with recent onset of focal neurological symptoms should be managed according to the continuing presence or absence of symptoms when assessed.

Focal symptoms include weakness of limb(s), facial weakness, and vision or speech disturbance.

Non-focal symptoms include generalised collapse, loss of consciousness, and confusion without focal signs.

Stroke Unit care (available in all NHSGGC hospitals) offers advantages in terms of mortality and time to discharge home for all stroke patients. Selected patients, approximately 10% of all admissions, may achieve additional advantage with IV thrombolysis. However, this requires to be given in specialised stroke units within 4.5 hours of the onset of symptoms or when last known to be well. Therefore, refer immediately to the acute stroke service either at:

• Queen Elizabeth University Hospital (QEUH)
• Glasgow Royal Infirmary (GRI) – service available 9am-5pm on weekdays (except public holidays)
• Royal Alexandria Hospital (RAH) - service available 9am-5pm on weekdays (except public holidays)

See the algorithm below, which outlines the admission process for patients presenting with focal symptoms.

General management and drug therapy

• Flowchart Management of suspected stroke or TIA

Guideline reviewed: September 2023