Clinical features

Altered mental status

Visual changes (e.g., diplopia/vision loss)

Dysphagia

Facial droop

Aphasia, dysarthria, word-finding

Focal motor impairment

Focal sensory impairment

Dizziness/vertigo

Ataxia

Loss of fine motor skills

Frontal release signs

Loss of executive function

Exam findings

Altered mental status

Neurologic findings—lateralizing signs

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  Neglect

  
  
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  Aphasia

  
  
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  Apraxia

  
  
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  Visual field deficits

  
  
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  Ocular palsies

  
  
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  Facial weakness

  
  
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  Hemiparesis

  
  
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  Hemisensory disturbance

  
  
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  Hemiataxia

Meningeal signs

Cardiovascular findings

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  Arrhythmia (e.g., atrial fibrillation, mitral/atrial stenosis)

  
  
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  Murmurs

Evidence of embolic disease

Management

Consult neurology immediately

Prepare patient for transfer to intensive care unit

Assess airway, breathing, and circulation

Vital signs to evaluate for hemodynamic instability, oxygen saturation, fever, respiratory drive

NPO except medications

Ensure administration of oxygen and placement of intravenous fluid access

Aspiration precautions

Medications

Do not administer aspirin, heparin, or other blood thinners until intracranial bleed is ruled out

Consider aspirin 160-325 mg/d

Do not treat hypertension

Diagnostic studies may include the following:

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  Arterial blood gases if hypoxic

  
  
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  12-lead EKG

  
  
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  Head CT non-contrast or MRI stroke protocol

  
  
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  Complete blood cell count with differential

  
  
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  Chemistry panel

  
  
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  Fingerstick glucose

  
  
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  Blood cultures if fever present

  
  
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  PT/INR and aPTT

  
  
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  Chest x-ray if suspect lung or heart disease

  
  
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  Toxicology screen