Predicts 3 month outcome in ischemic stroke patients receiving TPA.
- 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.
- Determine the onset of stroke symptoms (or time patient last felt or was observed normal).
- Obtain a stat head CT to evaluate for hemorrhagic stroke.
- 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.
- For patients with a DRAGON score that predicts a miserable outcome even if tPA is given, consider the risk/benefit of giving IV thrombolytics.
- These patients may also be potential candidates for endovascular thrombectomy, though the benefits of this procedure have not yet been demonstrated in the literature.
- All treatment decisions should be made in consultation with the patient and/or his/her family whenever possible.