Therapeutic Handbook - GGC Prescribing

Management of Acute Stroke 1Presentation with focal neurological symptoms,< 24 hoursIntroductionThe sudden onset of focal neurological symptoms implies a transient ischaemic attack (TIA) orstroke. A diagnostic distinction can sometimes be made between patients with suspected TIA orstroke. For management purposes, however, patients with the recent onset of focal neurologicalsymptoms should be managed according to the continuing presence, or absence, of symptoms whenassessed.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 withoutfocal signs.Stroke Unit care (available in all NHSGGC hospitals) offers advantages in terms of mortality and timeto 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 inspecialised stroke units within 4.5 hours of the onset of symptoms, or when last known to be definitelywell. Therefore, refer immediately without delay to the appropriate Acute Stroke Unit – the SouthernGeneral hospital for hospitals south of the river Clyde and the Western Infirmary hospital for thosenorth of the river.See algorithm on next page which outlines the admission process of patients presenting with focalsymptoms.Cardiovascular SystemContinues on next pagePage 117