• Appropriateness of decision to treat or not treat with thrombolytics [ Time Frame: potentially within 3 hours of symptom onset ] [ Designated as safety issue: Yes ]
  

• ICH rate (post rt-PA) [ Time Frame: potentially within 3 hours of symptom onset ] [ Designated as safety issue: Yes ]
  
• Number of thrombolytic administrations [ Time Frame: potentially within 3 hours of symptom onset ] [ Designated as safety issue: No ]
  
• Time to treatment decision for administration of thrombolytics [ Time Frame: potentially within 3 hours of symptom onset ] [ Designated as safety issue: No ]
  
• Technical observations [ Time Frame: Time of consultation ] [ Designated as safety issue: Yes ]
  

The Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) system is a digital video camera system that can transfer video and audio images from the clinic or emergency room to a distant (remote) place where a stroke specialist can review the images in real time (as they happen). This system uses site independent software to access the camera system from multiple locations. The study will determine if video consultation is superior to telephone consultation for remote evaluation or treatment of stroke patients, and the usefulness of this system in evaluating patients with suspected stroke symptoms. However, this method is being used in other fields of medicine for assistance in medical evaluations.

Participants will be randomly assigned to receive evaluation by either the video camera system or by telephone alone. For those assigned to the video camera system, the system will be activated and will record and transmit video and audio images to a stroke specialist located at a remote location. He/she may ask the participants questions relating to medical illnesses and current symptoms, and may also review laboratory tests and x-ray images using a computer, if available. The stroke specialist will also perform general physical and neurological examinations, which will take place by video camera with the assistance of a bedside physician who will perform the actual examinations.

For those participants assigned to the telephone-only consultation, the video system will not be activated, but the same procedure as above will be followed except the stroke specialist will not be able to see the participants or examine them using the video camera system. Participation in the study will last for the entire time the participants are in the hospital. Participants will be contacted by telephone by a study nurse 3 months post-stroke for a 10-minute interview regarding their current health. The total duration for individual participation is 3 months.

The study is part of the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS), which allows researchers to enhance and initiate translational research that ultimately will benefit stroke patients.