An ischemic stroke happens when a blood clot blocks an artery in the brain. Brain cells start dying within minutes, so time to treatment is everything.
Key symptoms
- Sudden face droop, arm or leg weakness on one side
- Speech trouble or confusion
- Sudden vision loss, loss of balance
- Severe headache is less common than in bleeding strokes
What you find on exam
- BE-FAST: balance, eyes, face, arm, speech, time
- Time last known well
- Blood glucose (low sugar can mimic a stroke)
- Stroke scale such as the NIH Stroke Scale
Tests
- Emergency brain CT or MRI to rule out bleeding
- Blood glucose, coagulation tests, ECG
- CT angiography to look for a large vessel blockage
Treatment basics
- Clot-dissolving medicine within the time window if eligible
- Clot removal (thrombectomy) for large vessel blockage in selected patients
- Control blood pressure per protocol, check swallowing before food
- Prevention: antiplatelets or anticoagulants, statins, blood pressure control
Red flags
- Symptoms getting worse
- Drop in consciousness
- Seizure at onset
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Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.