Frisiologia Renal

Emergency Evaluation and Diagnosis of Acute

Ischemic Stroke

1. An organized protocol for the emergency evaluation of

patients with suspected stroke is recommended (Class I;

Level of Evidence B). The goal is to complete an evaluation

and to begin fibrinolytic treatment within 60 minutes

of the patient’s arrival in an emergency department.

Designation of an acute stroke team that includes physicians, nurses, and laboratory/radiology personnel is

encouraged. Patients with stroke should have a careful

clinical assessment, including neurological examination.

(Unchanged from the previous guideline)

2. The use of a stroke rating scale, preferably the National

Institutes of Health Stroke Scale (NIHSS), is recommended

(Class I; Level of Evidence B). (Unchanged

from the previous guideline)

3. A limited number of hematologic, coagulation, and

biochemistry tests are recommended during the initial

emergency evaluation, and only the assessment of blood

glucose must precede the initiation of intravenous rtPA

(Table 8 in the full text of the guideline) (Class I; Level

of Evidence B). (Revised from the previous guideline)

4. Baseline electrocardiogram assessment is recommended

in patients presenting with acute ischemic stroke but

should not delay initiation of intravenous rtPA (Class

I; Level of Evidence B). (Revised from the previous

guideline)

5. Baseline troponin assessment is recommended in

patients presenting with acute ischemic stroke but should

not delay initiation of intravenous rtPA (Class I; Level of

Evidence C). (Revised from the previous guideline)

6. The usefulness of chest radiographs in the hyperacute

stroke setting in the absence of evidence of acute pulmonary, cardiac, or pulmonary vascular disease is unclear. If obtained, they should not unnecessarily delay administration of fibrinolysis (Class IIb; Level of Evidence B).

(Revised from the previous guideline)

Early Diagnosis: Brain and Vascular Imaging

For patients with acute cerebral ischemic symptoms that have not yet resolved:

1. Emergency imaging of the brain is recommended before

initiating any specific therapy to treat acute ischemic

stroke (Class I; Level of Evidence A). In most instances,

non–contrast-enhanced CT will provide the necessary

information to make decisions about emergency management.

(Unchanged from the previous guideline)

2. Either non–contrast-enhanced CT or MRI is recommende before intravenous rtPA administration to exclude intracerebral hemorrhage (absolute contraindication) and to determine whether CT hypodensity or MRI hyperintensity of ischemia is present (Class I; Level of Evidence A). (Revised from the 2009 imaging scientific statement)

3. Intravenous fibrinolytic therapy is recommended in

the setting of early ischemic changes (other than frank

hypodensity) on CT, regardless of their extent (Class I;

Level of Evidence A). (Revised from the 2009 imaging

scientific statement)

4. A noninvasive intracranial vascular study is strongly recommended during the initial imaging evaluation of the

acute stroke patient if either intra-arterial fibrinolysis or

mechanical thrombectomy is contemplated for management

but should not delay intravenous rtPA if indicated (Class I; Level of Evidence A). (Revised from the 2009 imaging scientific statement)

5. In intravenous fibrinolysis candidates, the brain imaging

study should be interpreted

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