• Public awareness and responsiveness.
• Patient and caregiver education.
• Stroke prevention. Life style and risk factor management.
• Stroke prevention. Blood pressure management.
• Stroke prevention. Lipid-management.
• Stroke prevention. Diabetes management.
• Stroke prevention. Antiplatelet therapy.
• Stroke prevention. Antithrombotic therapy in atrial fibrillation.
• Stroke prevention. Carotid intervention.
• Acute stroke management. Stroke unit care.
• Acute stroke management. Blood glucose.
• Acute stroke management. Acute thrombolytic treatment.
• Acute stroke management. Carotid artery imaging.
• Acute stroke management. Dysphagia assessment.
• Acute stroke management. Acute aspirin therapy.
• Acute stroke management. Management of subarachnoid and intracerebral hemorrhage.
• Stroke rehabilitation and community reintegration. Initial stroke rehabilitation assessment.
• Stroke rehabilitation and community reintegration. Provision of inpatient stroke rehabilitation.
• Stroke rehabilitation and community reintegration. Components of inpatient stroke rehabilitation.
• Stroke rehabilitation and community reintegration. Identification and management of post-stroke depression.
• Stroke rehabilitation and community reintegration. Shoulder pain assessment and treatment.
• Stroke rehabilitation and community reintegration. Community-based rehabilitation.
• Follow-up and community reintegration after stroke.

Best Practice Recommendation

All patients with suspected acute stroke should undergo brain imaging immediately. In most instances, the modality of choice is a non-contrast computer-assisted tomographic (CT) scan. If magnetic resonance imaging (MRI) is performed, the scan should include diffusion-weighted sequences to detect ischemia, and gradient echo and fluid-attenuated inversion recovery (FLAIR) sequences for hemorrhage. (Evidence Level B)

Rationale

Clinicians disagree on the clinical diagnosis of stroke (versus not stroke) in about 20% of patients. It is impossible to differentiate infarct from hemorrhage on clinical grounds. Brain imaging is required to guide management, including the selection of acute, time-sensitive interventions. In a decision-analysis model, a policy of 'scan all immediately' was more cost-effective than 'scan all within 48 hours' or 'scan patients on anticoagulants or in a life-threatening condition immediately and the rest within 14 days.'

Definitions:

Levels of Evidence

Several rating systems are used by guideline developers to evaluate the strength of the evidence for their recommendations. These systems vary in the nomenclature used (alpha versus numeric), but there is usually reasonable equivalence in the definitions across the levels of evidence. Each recommendation in the original guideline document provides the levels of evidence for the recommendation as well as the reference for the Primary Guideline(s) that were adapted or contributed most to the wording of the recommendation.

*Refer to Appendix One in the original guideline document for a detailed table defining the evidence rating system used by each primary guideline referenced in this document.

Electronic copies: Available from the Canadian Stroke Strategy Web site.

Print copies: Available from The Canadian Stroke Strategy, 451 Smyth Road, Room 3105, Ottawa, Ontario K1H 8M5.

• Canadian Stroke Strategy performance measurement manual: a supplement to the Canadian best practice recommendations for stroke care. 2007 May. 35 p. Electronic copies: Available in Portable Document Format (PDF) from the Canadian Stroke Strategy Web site.
• Stroke prevention cards: risk stratification for early stroke recurrence following TIA. 2 p. Electronic copies: Available in Portable Document Format (PDF) from the Canadian Stroke Strategy Web site.
• Integrated stroke care in Ontario: stroke evaluation report 2006. 2007 Jul. 72 p. Available in Portable Document Format (PDF) from the Canadian Stroke Strategy Web site.
• Stroke services and resources inventory: a national survey initiative. 2007 Jun. 36 p. Available in Portable Document Format (PDF) from the Canadian Stroke Strategy Web site.

Print copies: Available from The Canadian Stroke Strategy, 451 Smyth Road, Room 3105, Ottawa, Ontario; K1H 8M5.

Additionally, suggested performance measures are available in the original guideline document.

A variety of patient information resources, including a list of stroke warning signs, is available from the Heart & Stroke Foundation of Canada Web site.

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .

NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding guideline content are directed to contact the guideline developer.