Evidence-Based Stroke Protocols Flashcards

Evidence-based fever management in acute stroke recommends treating hyperthermia with antipyretics when temperature exceeds:

Answer: 38.0°C (100.4°F)

AHA/ASA guidelines recommend treating fever >38°C (100.4°F) in acute stroke patients, as hyperthermia worsens neurological outcomes by increasing metabolic demand in ischemic tissue.

Which validated prehospital stroke screening tool has the highest sensitivity for detecting large vessel occlusion strokes in the field?

Answer: Vision, Aphasia, Neglect (VAN) assessment

The VAN assessment has demonstrated higher sensitivity for detecting LVO strokes in prehospital settings compared to FAST-based tools by specifically testing cortical signs.

Per AHA/ASA evidence-based protocols, which glucose range should be maintained in acute ischemic stroke patients?

Answer: 80–140 mg/dL

AHA/ASA guidelines recommend maintaining blood glucose between 80–140 mg/dL in acute stroke, avoiding both hypoglycemia and hyperglycemia, which both worsen neurological outcomes.

A stroke patient develops symptomatic hemorrhagic transformation after IV tPA. According to protocol, what is the first-line reversal agent?

Answer: Cryoprecipitate containing fibrinogen

Cryoprecipitate (containing fibrinogen and factor VIII) is the first-line reversal agent for alteplase-induced hemorrhagic transformation because alteplase depletes fibrinogen.

The ENCHANTED trial compared low-dose alteplase (0.6 mg/kg) versus standard-dose alteplase (0.9 mg/kg) in acute ischemic stroke. Its primary conclusion was:

Answer: Low-dose had significantly less symptomatic intracranial hemorrhage but was not non-inferior for functional outcomes

ENCHANTED showed low-dose alteplase reduced symptomatic intracranial hemorrhage but failed to demonstrate non-inferiority for the primary functional outcome compared to standard dose.

In evidence-based stroke unit care, which intervention has the strongest Level A evidence for reducing stroke mortality and dependence?

Answer: Organized inpatient stroke unit care with a dedicated multidisciplinary team

Cochrane meta-analyses provide the strongest evidence that organized stroke unit care with a dedicated multidisciplinary team reduces death, dependency, and institutionalization compared to general ward care.

Per the ESUS (Embolic Stroke of Undetermined Source) trial results, which secondary prevention strategy is currently recommended for ESUS patients?

Answer: Antiplatelet therapy (aspirin or clopidogrel) remains the standard pending identification of a cardioembolic source

The NAVIGATE ESUS and RE-SPECT ESUS trials failed to show DOAC superiority over aspirin in unselected ESUS patients; antiplatelet therapy with continued source investigation remains standard.