Acute management |
Keep temperature between 36.5°C and 37°C |
Treat acute seizures |
For haemorrhagic stroke |
Immediate referral to a centre with neurosurgical facilities (?for drainage) |
For cerebellar stroke presenting in coma |
Referral to a centre with neurosurgical facilities (?for drainage hydrocephalus or decompression) |
For large middle cerebral artery territory lesions presenting in coma |
Referral to a centre with neurosurgical facilities (?for decompression) |
For stroke in sickle cell disease |
Exchange transfusion |
For ischaemic stroke occurring in hospital and imaged within three hours |
Consider intravenous tissue plasminogen activator |
For venous sinus thrombosis, extracranial arterial dissection, and known prothrombotic disorder |
Heparin acutely |
Warfarin for three to six months |
For strokes secondary to other mechanisms |
Early prophylaxis with low dose aspirin (1 mg/kg) |
For all |
Early rehabilitation by team comprising nursing staff, physiotherapist, occupational therapist, speech therapist, and psychologist |
Prevention of recurrence |
For sickle cell disease |
Regular transfusion (4–6 weekly) to keep haemoglobin S < 20% |
For moyamoya |
Consider revascularisation, particularly if transient ischaemic attacks or cognitive decline |
For homozygotes for the thermolabile methylene tetrahydrofolate reductase gene |
B complex vitamin supplementation |
For those with an important prothrombotic disorder or extracranial arterial dissection |
Consider warfarin (discuss with haematologist in individual case) |
For others with stroke in a vascular distribution and/or cerebrovascular disease |
Low dose aspirin 1 mg/kg |