EM · Acute ischaemic stroke
Acute ischaemic stroke
Also known as Acute ischemic stroke · Cerebral infarction · Acute stroke · Brain attack
Acute ischaemic stroke in the emergency department — recognition (FAST, BE-FAST, ROSIER), glucose, imaging, tenecteplase or alteplase within 4.5 hours, extended-window thrombolysis, thrombectomy to 24 hours, blood pressure, and complications, aligned to the 2026 AHA/ASA guideline.
Checked against its sources on 23 Oct 2026
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Red flags
- The typical patient loses 1.9 million neurons each minute that stroke is untreated
- Do not delay thrombolysis for CT angiography or perfusion imaging in eligible patients within 4.5 hours
- Tenecteplase 0.4 mg/kg is not recommended; use 0.25 mg/kg (maximum 25 mg)
- Malignant MCA infarction carries an 80 per cent mortality; decompressive craniectomy within 48 hours significantly reduced mortality in pooled trials
Meet the patient
A 68-year-old woman is found by her husband with a facial droop, slurred speech and a weak right arm. She was last seen well 90 minutes earlier. The ambulance crew have pre-notified the department.
Every minute matters. In patients experiencing a typical large-vessel acute ischaemic stroke, 1.9 million neurons, 14 billion synapses and 12 km of myelinated fibres are destroyed each minute.[17]
References28ShowHide
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