THRIVE Score for Stroke Outcome

• Consult Neurology immediately (if available) for all patients presenting with ischemic stroke.
• Evaluate whether the patient is a potential candidate to receive intravenous thrombolysis (tPA).
• Consider further imaging including CT, CT angiography and MRI/MRA.

In patients who present with symptoms concerning for ischemic stroke:

• Consult Neurology immediately (if available) for all patients presenting with ischemic stroke.
• Determine the onset of stroke symptoms (or time patient last felt or was observed normal).
• Consider further imaging including CT, CT angiography and MRI/MRA.
• In appropriate circumstances and in consultation with both neurology and the patient, consider IV thrombolysis for ischemic strokes in patients with no contraindications.
• Always consider stroke mimics in the differential diagnosis, especially in cases with atypical features (age, risk factors, history, physical exam), including:
  • Recrudescence of old stroke from metabolic or infectious stress;
  • Todd’s paralysis after seizure;
  • Complex migraine;
  • Pseudoseizure, conversion disorder.

• The THRIVE score provides reliable early information about the baseline odds of recovery and prognosis in an acute ischemic stroke patient.
• This information may help guide physicians as well as inform discussions with patients and their families when weighing the risks and benefits of various treatment options.