Introduction

The aims of acute management are:

• Restoration of brain perfusion to reduce the effects of the primary insult and prevent secondary brain injury
• Effective stroke care. Effective stroke care is multi-disciplinary. The stroke team, radiology and the stroke unit should be contacted early.
• Thrombolysis. Patients presenting within a few hours of symptom onset may benefit from administration of the thrombolytic agent tissue plasminogen activator (rt-PA). The patient should, therefore, have a focussed medical history, including exact time of onset of symptoms, and be urgently assessed for the inclusion and exclusion criteria of stroke thrombolysis

In the past, patients were eligible for thrombolysis if they presented within three hours of symptom onset. This was extended to 4.5 hours following publication of the European Cooperative Acute Stroke Study (ECASS) III trial in patients aged 18-80 [11]

Learning Bite

The evidence base for thrombolysis for acute ischaemic stroke indicates benefit if delivered within 4.5 hours.