Current Topics in Acute Stroke Care - Stroke EXTRA Supplement (Stroke CME) -

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Publication Date: July 2020 (Volume 22, Supplement 7)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 07/15/2023. This course is included with an Emergency Medicine Practice subscription

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Stroke credits, subject to your state and institutional approval.

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Introduction

Clinicians are highly likely to encounter patients with stroke in the emergency department and must be able to diagnose and manage stroke in a timely and effective manner to opti-mize patient outcomes. Emergency department management of stroke includes utilizing imaging appropriately based on the type of stroke, assessing patient risk for additional cardiovascular or stroke events, and recognizing subtle or different forms of stroke, such as patients who have normal initial imaging or patients who present with a central retinal artery occlusion. This supplement reviews these aspects of stroke management and provides useful management strategies that can be applied to practice.

Excerpt From This Issue

Acute focal neurological deficits secondary to a vascular condition include acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Imaging tools, such as computed tomography (CT), magnetic resonance imaging (MRI), and angiography, can assess and diagnose each subtype quickly so that emergent treatment can be provided. In all stroke subtypes, rapid diagnosis and management can lead to improved functional outcomes.

Clinical suspicion of stroke—based on symptoms of new-onset hemiparesis, vision loss, sensory loss, double vision, vertigo, or ataxia—should be managed with rapid evaluation and noncontrast head CT in nearly all cases. While other imaging modalities can provide more precise information, the noncontrast head CT can distinguish between hemorrhage and ischemic stroke. Head CT can be obtained quickly and is usually adequate to make emergent treatment decisions. The American Heart Association/American Stroke Association guidelines recommend emergent noncontrast head CT within 10 minutes of patient arrival, with Class I, Level A evidence.¹