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Acute Stroke

Also known as: CVA · brain attack · cerebrovascular accident · ischaemic stroke

A sudden focal neurological deficit from cerebral ischaemia (or haemorrhage). “Time is brain” — urgent imaging then reperfusion for eligible ischaemic stroke.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Older adults; risk rises with hypertension, atrial fibrillation, diabetes, smoking, dyslipidaemia and a prior TIA/stroke.

Red flags — escalate / refer

Sudden Face droop, Arm weakness or Speech difficulty (FAST) — note the time of onset → activate the stroke pathway NOW.
Reduced consciousness, severe headache or vomiting may signal haemorrhage.
Always exclude hypoglycaemia — it can mimic stroke.

Work-up / diagnosis

1Urgent non-contrast CT head to distinguish ischaemic from haemorrhagic stroke BEFORE any antithrombotic or thrombolysis.
2Check capillary glucose immediately; ECG (atrial fibrillation); baseline bloods.
3Quantify the deficit (NIHSS) and establish the last-known-well time to judge reperfusion eligibility.

Management — overview

Ischaemic stroke, eligible + in window: IV thrombolysis (ideally ≤4.5 h from onset); consider mechanical thrombectomy for large-vessel occlusion (up to 24 h in selected patients).
Not for thrombolysis: give aspirin once haemorrhage is excluded on CT, within 24–48 h.
Supportive: protect airway, keep glucose and oxygen in range, use permissive blood-pressure targets (do not lower aggressively unless thrombolysing or extreme), assess swallow (keep nil-by-mouth until safe), mechanical DVT prophylaxis and early rehabilitation.
Haemorrhagic stroke: reverse any anticoagulation, control blood pressure, and refer to neurosurgery.
Secondary prevention: antiplatelet (or anticoagulation for AF), a high-intensity statin, and blood-pressure/risk-factor control.

In-depthFull dosing & advanced protocol

Drug dosing

Alteplase (IV thrombolysis)

Eligible ischaemic stroke ≤ 4.5 h

Adult dose: 0.9 mg/kg IV (max 90 mg): 10% as a bolus, the rest over 60 min
Route: Intravenous

Caution: Only after CT excludes haemorrhage and contraindications are screened; tenecteplase is an alternative in some centres.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Aspirin

Ischaemic stroke not for/after thrombolysis

Adult dose: 300 mg once (oral or rectal) after CT excludes bleed, then 75 mg daily
Route: Oral / rectal

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

High-intensity statin (atorvastatin)

Secondary prevention

Adult dose: 40–80 mg once daily
Route: Oral

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Reperfusion, BP & TIA

Thrombolysis eligibility hinges on time window, imaging and a contraindication checklist; thrombectomy benefits large-vessel occlusion.
Blood pressure: lower to <185/110 before thrombolysis; otherwise treat permissively in acute ischaemic stroke.
TIA is a warning — assess urgently (e.g. ABCD2), start antiplatelet + risk-factor control to prevent stroke.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

HypertensionPersistently raised arterial pressure (≥140/90 mmHg) — a leading, modifiable cause of stroke, heart attack, heart failure and kidney disease.DengueAn Aedes-borne viral febrile illness. Most cases self-limit, but plasma leakage can cause severe dengue — early recognition of warning signs and careful fluid therapy save lives.MalariaA mosquito-borne protozoal (Plasmodium) febrile illness. In India P. vivax and P. falciparum predominate; prompt diagnosis and species-specific treatment prevent severe disease.

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Acute Stroke

Also known as: CVA · brain attack · cerebrovascular accident · ischaemic stroke

A sudden focal neurological deficit from cerebral ischaemia (or haemorrhage). “Time is brain” — urgent imaging then reperfusion for eligible ischaemic stroke.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

Work-up / diagnosis

1Urgent non-contrast CT head to distinguish ischaemic from haemorrhagic stroke BEFORE any antithrombotic or thrombolysis.

2Check capillary glucose immediately; ECG (atrial fibrillation); baseline bloods.

3Quantify the deficit (NIHSS) and establish the last-known-well time to judge reperfusion eligibility.

Management — overview

Ischaemic stroke, eligible + in window: IV thrombolysis (ideally ≤4.5 h from onset); consider mechanical thrombectomy for large-vessel occlusion (up to 24 h in selected patients).

Not for thrombolysis: give aspirin once haemorrhage is excluded on CT, within 24–48 h.

Supportive: protect airway, keep glucose and oxygen in range, use permissive blood-pressure targets (do not lower aggressively unless thrombolysing or extreme), assess swallow (keep nil-by-mouth until safe), mechanical DVT prophylaxis and early rehabilitation.

Haemorrhagic stroke: reverse any anticoagulation, control blood pressure, and refer to neurosurgery.

Secondary prevention: antiplatelet (or anticoagulation for AF), a high-intensity statin, and blood-pressure/risk-factor control.

Drug dosing

Alteplase (IV thrombolysis)

Eligible ischaemic stroke ≤ 4.5 h

Adult dose: 0.9 mg/kg IV (max 90 mg): 10% as a bolus, the rest over 60 min
Route: Intravenous

Caution: Only after CT excludes haemorrhage and contraindications are screened; tenecteplase is an alternative in some centres.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Aspirin

Ischaemic stroke not for/after thrombolysis

Adult dose: 300 mg once (oral or rectal) after CT excludes bleed, then 75 mg daily
Route: Oral / rectal

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

High-intensity statin (atorvastatin)

Secondary prevention

Adult dose: 40–80 mg once daily
Route: Oral

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Reperfusion, BP & TIA

Thrombolysis eligibility hinges on time window, imaging and a contraindication checklist; thrombectomy benefits large-vessel occlusion.

Blood pressure: lower to <185/110 before thrombolysis; otherwise treat permissively in acute ischaemic stroke.

TIA is a warning — assess urgently (e.g. ABCD2), start antiplatelet + risk-factor control to prevent stroke.

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Alteplase (IV thrombolysis)

Aspirin

High-intensity statin (atorvastatin)

📈 Reperfusion, BP & TIA

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Alteplase (IV thrombolysis)

Aspirin

High-intensity statin (atorvastatin)

📈 Reperfusion, BP & TIA

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Reperfusion, BP & TIA

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Reperfusion, BP & TIA

References