Acute ischemic stroke is a challenging and time-sensitive diagnosis. Diagnosis begins with rapid detection of acute stroke symptoms by the patient, their family or caregivers, or bystanders. If acute stroke is suspected, EMS providers should be called for rapid assessment. EMS providers will utilize prehospital stroke tools to diagnose and determine potential stroke severity. Once at the hospital, the stroke team works rapidly to solidify the patient history, perform a focused neurologic examination and obtain necessary laboratory tests and brain imaging to accurately diagnose acute ischemic stroke and properly treat the patient.
Key points
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Public education and awareness of the signs and symptoms of acute ischemic stroke (AIS), via education campaigns such as the FAST mnemonic or the “suddens” message, is an essential first step in making a timely diagnosis in patients suffering an AIS.
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In their determination of whether a patient is suffering an AIS, emergency medical service providers should use focused tools, such as the Cincinnati Prehospital Stroke Scale or the Los Angeles Prehospital Stroke Screen. Prehospital scales to further evaluate for stroke severity are currently being developed and studied.
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The diagnosis of AIS is made using a combination of patient history, clinical examination, and brain imaging.
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Time of symptom onset, or time that the patient was last symptom-free, is the most important piece of historical data obtained in the evaluation of a patient with suspected AIS.
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The primary goal of brain imaging in the evaluation of a patient with suspected AIS is to exclude intracranial hemorrhage. The benefit of treatment with endovascular therapy in selected patients has expanded the role of imaging to also evaluate for the presence of an intravascular thrombus, the size of irreversible infarcted tissue, and potentially the amount of hypoperfused tissue at risk for infarction.
Introduction
Acute ischemic stroke (AIS) is defined as an episode of neurologic dysfunction caused by focal cerebral, spinal, or retinal cell death attributable to ischemia, based on (1) pathologic, imaging or other objective evidence of cerebral, spinal cord, or retinal focal ischemic injury in a defined vascular distribution; or (2) clinical evidence of cerebral, spinal cord, or retinal focal ischemic injury based on symptoms persisting 24 or more hours or until death, and other causes excluded. ( Fig. 1 ).
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