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FOCUSED SHIFT VIEW

Focal Neurologic Deficit / Suspected Stroke

Time last known well, glucose, disability, imaging, reperfusion team.

Open full pathway
Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. Record last-known-well, baseline function, anticoagulants, glucose, and deficit severity.
  2. Activate the local stroke pathway; noncontrast CT excludes hemorrhage and vascular imaging selects thrombectomy candidates.
  3. Do not let a low NIHSS dismiss a disabling deficit; reperfusion eligibility is protocol- and imaging-dependent.

2 · Escalate now if

  • Disabling aphasia, neglect, hemiparesis, or visual loss
  • Reduced consciousness or brainstem/posterior-circulation signs
  • Thunderclap headache, vomiting, meningismus, or seizure
  • Neck pain after minor trauma or new Horner syndrome
  • Anticoagulation or severe hypertension with neurologic change

3 · Immediate workup

  • Bedside glucose, ECG, CBC/coagulation and type/screen without delaying imaging
  • Noncontrast CT; CTA head/neck and perfusion/advanced imaging per local stroke protocol

4 · Don’t miss

  • Acute ischemic stroke with disabling deficit
    Rapid stroke-team assessment; IV thrombolysis and/or thrombectomy eligibility follows local protocol and imaging.
  • Intracranial hemorrhage
    CT first; control physiology and reverse anticoagulation per local pathway.
  • Basilar artery occlusion
    Vertigo, diplopia, dysarthria, weakness, coma, or fluctuating signs demand posterior-circulation vigilance.

5 · Disposition lane

Stroke unit

Confirmed stroke/TIA, persistent deficit, or incomplete etiologic assessment.

Resuscitation / neuro-ICU / thrombectomy centre

Reperfusion candidate, hemorrhage, large-vessel occlusion, declining consciousness, or airway risk.