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DRAGON Score for Post-TPA Stroke Outcome

Predicts 3 month outcome in ischemic stroke patients receiving TPA.

Advice

  • 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.

Management

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.

Critical Actions

  • 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.
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