Suspected Stroke Clinical Pathway, Emergency Department – Initial Treatment Guidelines

Suspected Stroke Clinical Pathway — Emergency Department

Initial Treatment Guidelines

Continue neuroprotective interventions:

Hyperacute Therapy
  • Consider if eligible for tPA or thrombectomy
  • Children presenting within 4.5 hrs of last witnessed to be well (without deficits) might be eligible for tPA
  • Children presenting within 24 hrs of last witnessed to be well (without deficits) may be eligible for thrombectomy
  • Call Stroke Team to mobilize hyperacute imaging and treatment
Antithrombotic Treatment
  • Children with suspected acute ischemic stroke with CT negative for an acute hemorrhage should be given an initial dose of aspirin
  • Systemic anticoagulation is reserved for selected diagnoses with discussion with Stroke Team
    • Arterial dissection
    • Cardiogenic embolic stroke
    • Venous thrombosis
Anti-Seizure Medication
  • Treat acute symptomatic seizure occurring at or around stroke symptom onset
  • If history of seizure, review anti-seizure medication with Stroke Team
Initial/Admission Lab and Risk Factor Screening Studies
  • Assure the following have been obtained:
    • CBC, platelet count
    • PT, PTT, INR
    • BMP
    • EKG
  • Other labs (e.g., thrombophilia or vasculitis workup) should be discussed with Stroke Attending and admitting service
Special Cases
  • STAT consult to hematology for children with sickle cell anemia to discuss:
    • Imaging recommendations
    • Need for exchange transfusion
    • Need for simple transfusion
  • Thrombolysis is not usually used in patients with sickle cell anemia or Moyamoya disease