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ForwardDifferent Strokes: A Modern Guide to Acute Stroke Management
This educational activity provides a comprehensive, evidence-based overview of acute ischemic stroke care, guiding learners from the initial emergency department evaluation through inpatient diagnostic workups and secondary prevention. The curriculum covers the foundational steps of clinical assessment, including NIHSS scoring and stroke localization, alongside the interpretation of acute neuroimaging modalities like CT Perfusion and MRI to make time-sensitive reperfusion decisions. Furthermore, the activity provides an in-depth review of the 2026 AHA Acute Ischemic Stroke Guideline updates concerning eligibility for intravenous thrombolytics and endovascular thrombectomy. Finally, learners will explore targeted inpatient etiologic workups utilizing the TOAST criteria and learn to develop etiology-specific secondary stroke prevention strategies, all practically applied through an interactive, complex case study.
Target Audience
- Physicians
- Physician Assistants
- Advanced Practice Nurses
- Registered Nurses
- Licensed Practical Nurses
- Other
Learning Objectives
Learners will be able to:
- Identify the accurate Time Last Well (TLKW) based on patient and witness history.
- Describe an accurate NIH Stroke Scale (NIHSS) score to quantify neurologic deficits in the acute setting.
- Explain clinical signs and symptoms (such as aphasia, hemineglect, or ataxia) with specific anterior or posterior cerebral vascular territories to localise the stroke.
- Identify early and subacute ischemic changes on a Non-Contrast CT of the head.
- Recognize large vessel occlusions (LVOs) in the anterior and posterior circulation using CT Angiography (CTA).
- Differentiate between the core infarct and the salvageable penumbra using CT Perfusion (CTP) metrics to guide extended-window treatments.
- Describe MRI sequences (DWI and FLAIR) to identify acute ischemia and guide treatment decisions for "WAKE-UP" strokes.
- Evaluate patients for intravenous thrombolytic (IVT) eligibility by applying major contraindications and the 2026 AHA Acute Ischemic Stroke Guideline updates.
- Determine appropriate candidates for endovascular thrombectomy (EVT), including those with large vessel occlusions, basilar artery occlusions, and select medium or distal occlusions.
- Classify the underlying cause of an ischemic stroke using the TOAST criteria (Large artery, Small vessel, Cardioembolic, ESUS, or Other).
- Describe a targeted inpatient diagnostic workup, including vascular imaging, echocardiography (TTE/TEE), prolonged cardiac monitoring, and hypercoagulability testing when indicated.
- Develop an aetiology-specific secondary stroke prevention plan involving targeted medical management (antiplatelets vs. anticoagulation) and strict modification of risk factors (lipids, glucose, blood pressure).