Tuesday, September 20, 2011

Resources for Acute Stroke evaluation and treatment

This post is really just for me - so I can find a few certain documents without frantic Googling when the 3 hour clock is ticking...

AHA/ASA - Guidelines for the Early Management of Adults With Ischemic Stroke

 ACEP - Use of IV tPA for the Management of Acute Stroke in the ED

AHA/ASA Science Advisory - Expansion of the Time Window for Treatment of Acute Ischemic Stroke With Intravenous Tissue Plasminogen Activator (del Zoppo)

ECASS III Exclusion Criteria 
Expansion of TPA window to 4.5 hours by AHA (Stroke 2009;40:) - ECASS III
  • Age < 18 or > 80 years
  • Onset of stroke > 4.5 hours before drug administration or symptom onset unknown
  • Stroke symptoms present < 30 minutes or significantly improving before treatment
  • Intracranial hemorrhage
  • Severe stroke as defined by NIHSS > 25 or imaging (CT or MRI) displaying > 1/3 of middle cerebral artery territory involved
  • Seizure at the onset of stroke
  • --------
  • Stroke or serious head trauma within the previous 3-months 
  • Major surgery or severe trauma within 3-months
  • Combination of previous stroke and diabetes mellitus
  • --------
  • SBP > 185 mm Hg or DBP > 110 mm Hg or IV treatment to reduce BP to these limits
  • Glucose < 50 mg/dL or > 400 mg/dL
  • Symptoms suggestive of subarachnoid hemorrhage even if CT normal
  •  -------
  • Heparin within the preceding 48 hours with PTT above normal limit
  • Platelet count < 100,000 mm3
  • Oral anticoagulation therapy (EVEN IF INR WNL)
  • Other major disorders with an increased risk of bleeding



  1. That AAEM guide is about the best risk-benefit publication I've ever seen. I've used it three times, and never pushed tPA. I wish we had more handouts like that...

  2. Educate the patient and family, know the inclusion and exclusion criteriae, and avoid the tPA hype!

  3. I'm writing to express my profound gratitude to great spiritual doctor i have ever met who has healed me from stroke, I have been stroke down for over 3 years and I suffer so badly for years to an extent my marriage was broken, I meant with different doctors but no one was able to cure my stroke and some of these doctor told me that there's no cure for stroke which i almost believe them but I never knew that doctor muzack is going to prove them wrong which he actually did, i never know doctor muzack but a friend of mine recommended him to me, I found out he was an online spiritual doctor, i contact him directly on his email address tradomedicalhealer@gmail.com, I told him my problems, he told me what to do, which i did and he prepared herbal products and send it over to me here in my country, i took it as he directed for just four days, it was a miracle, I was heal from stroke and I'm even stronger than ever. I know that there are so many people who are passing through different types of sickness and pain try to give doctor muzack a trial, if he responds to you then know that's your problems has come to an end, his contact info +2347037791346,,, tradomedicalhealer@gmail.com

  4. God have been very kind to me, despite the hard times he made me go through but now I give him all the praise for relieving my mum of her stroke through the help of an herbal doctor by name Uwadia Amenifo. Helen Smith is my name, and we live in England. My mum was diagnosed of stroke eight months ago, and she was in so many pains as she can’t even walk, go to rest room, or move her body. She even has to excrete in her body most times. I am her only child, and I so much love my mum because my dad died when I was 4 years old. So I grew up in the hands of only my mum without fatherly care. It happened that when she was diagnosed of stroke by our family doctor her condition was still good by then, but in just one month after her diagnoses, her condition became very worst that the doctor then said her stroke is acute and no longer partial. And that it will only take God’s intervention for her to be well again and for her to be able to retain the full use of her brain. So her ailment continues until God intervened before God’s intervention, I have carried her to so many churches for prayers and have traveled very far to look for a cure for her. I Travelled to America to see some doctors if they can help even if its surgery they can carry out on her provided she don’t die, because I really needed her around me. It was in America an Endocrinologist by name Jill Marie Abelseth MD from Albany, NY told me about an herbal doctor who she knows of, that have successfully cured stroke/ human parasites. So she advised me to contact the herbalist, so I contacted him, and explained to him what my mum is going through, so he counseled us and asked few questions about my mum which I told him. So he prepared the herbs, and shipped it to me in England. I gave my mum the herbs just as he has instructed, and just exactly as he said that his herbs will totally cure my mum. His herbs really worked perfectly well, and cured my mum. As I write this testimony my mum is totally cured of her stroke and she has started her normal business as usual. So I want all here to help me thank Doctor Uwadia Amenifo for his great help in helping me cure my mum of her stroke with his herbal medicine. Please if you know of anyone who have stroke or who have one disease or the other and his/her doctor says there’s no cure to that disease please I want that person to contact doctor Uwadia Amenifo, and give him a try. His contacts are Email (doctoruwadiaamenifo@gmail.com) his number is (+2349052015874), Thanks.

  5. This information will greatly help the stroke patients, I suffered a massive ischemic stroke, I was forced to give up work after having a stroke, but the medication I used proved there is life after stroke and decide to share my testimony. It is a misconception that strokes can not be cured or reversed as stated by professionals. I am living proof that improvement and cure is certain with Herbal Medicine, death from stroke can be defeated. When I had the stroke, I felt trapped inside my body. I knew that everything that was 'me' was still there, but I couldn't communicate. It was the hardest thing I’ve ever gone through. With the Herbal Medicine, and his recommended healthy diet, I consider myself regaining as much as 99.9% back to my old normal and satisfied. It is in short, an answer to prayer. I'd recommend any stroke patient to contact Dr. Allen for advice and more information with email:drallenchase@gmail.com

  6. ALL THANKS TO DR WILLIAMS FOR THE GREAT DEED HE HAVE DON FOR MY FAMILY.This information will be useful for Epilepsy and stroke patients who is willing to use herbal medicine. My daughter had temporal lobe epilepsy, She had seizure and had a grand mal with rage episode. Our daughter's seizure is constant throughout the day. We had used several medicine which include: Epilim and Keppra, experience seizure control at the cost of serious debilitating side effects. It was during a casual conversation with a friend that I learned about herbal Dr. William on how he help her cure his son from stroke,his medicine does not have any side effect. I am glad to say that he has been seizure-free since July 2015 after taking William medicine. this a miracle cure?contact him for more detail (drwilliams098765@gmail.com)