Acute Stroke Protocols (Ischemic & Hemorrhagic)
Thrombolysis windows, NIHSS scoring, and secondary prevention after TIA.
IV Thrombolysis (Alteplase/Tenecteplase)
The standard window is within 4.5 hours of last known normal. Strict inclusion and exclusion criteria apply regarding bleeding risk and blood pressure control (must be < 185/110 mmHg prior to administration).
Mechanical Thrombectomy
Indicated for emergent large vessel occlusion (ELVO) in the anterior circulation up to 24 hours from last known normal, based on DAWN and DEFUSE-3 trial criteria (utilizing perfusion imaging to identify penumbra).
Common Clinical Mistakes
- Premature anchoring on common diagnoses without evaluating red flags.
- Over-reliance on neuroimaging while neglecting detailed physical exams.
- Suboptimal dosing of first-line agents before declaring treatment failure.
Frequently Asked Questions
- When is immediate specialist referral required?
- Urgent referral is indicated for sudden onset of severe symptoms, rapidly progressive deficits, or when standard therapies fail.
- What are the primary outcome measures in recent clinical trials?
- Most contemporary trials focus on slowing disease progression (e.g., EDSS in MS, UPDRS in Parkinson's) and reducing relapse/event rates.
- How does this condition impact patient life expectancy?
- While highly variable, modern disease-modifying therapies have significantly improved long-term survival rates across neurodegenerative and neuroimmunological disorders.