Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Stroke Activation

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In one line

·When brain tissue is starving for blood, every minute counts — fast action can save brain cells and reverse damage.

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Normal physiology

·The brain floats in a pool of blood delivered by four main highways: two carotid arteries in the front and two vertebral arteries in the back, which join together at the base of the skull to form a safety ring called the Circle of Willis, then branch out into smaller arteries that deliver oxygen-rich blood to every neighborhood of brain tissue.

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What goes wrong

·A stroke happens when one of the brain's arteries either gets clogged by a clot (ischemic stroke, about 87% of all strokes) or bursts and bleeds into the brain (hemorrhagic stroke, about 13%), cutting off blood flow so that brain cells downstream start dying within minutes.

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Hallmark signs

·Sudden weakness or numbness on one side of the face, arm, or leg
·Sudden trouble speaking or understanding words (slurred speech or confused answers)
·Sudden vision loss in one or both eyes, or double vision
·Sudden severe headache (often called the worst headache of my life)
·Sudden trouble walking, loss of balance, or dizziness
·Sudden confusion or trouble understanding what is happening around them
·High or low blood pressure reading at the time of symptom onset
·High or low blood sugar reading

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Red flags · escalate now

·Symptoms started suddenly—within seconds or minutes—rather than building slowly over hours or days.
·The person cannot lift both arms to the same height, one side of the face droops when they smile, or their speech is slurred or makes no sense (positive FAST screen).
·Worst headache of my life, especially with stiff neck, vomiting, or sudden collapse—suggests bleeding in the brain (hemorrhagic stroke) rather than a clot.
·Symptoms are still present when emergency help arrives—do NOT wait to see if they go away, because every minute of lost blood flow kills about two million brain cells.
·History of atrial fibrillation (an irregular, quivering heartbeat) (irregular heartbeat), recent heart attack, or use of blood thinners—raises the chance of a stroke caused by a clot traveling from the heart or a dangerous bleed.

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Workup

·Non-contrast CT of the head
·CT angiography (CTA) of the head and neck
·Finger-stick blood glucose
·Electrocardiogram (ECG)
·Complete blood count (CBC) and platelet count
·PT/INR (prothrombin time / international normalized ratio)
·Troponin and serial ECGs if chest pain or heart history

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Treatment

·Activate the stroke team and document exact time last known well
·Non-contrast CT of the head immediately (door-to-CT goal under 20 minutes)
·Check and correct blood glucose if below 60 mg/dL
·Give IV alteplase (tPA) 0.9 mg/kg (max 90 mg) or IV tenecteplase (TNK) 0.25 mg/kg within 4.5 hours of symptom onset
·Mechanical thrombectomy (catheter-based clot retrieval) within 6 hours for large-vessel blockage (occlusion), up to 24 hours if imaging shows salvageable tissue
·Control blood pressure carefully — keep below 185/110 mmHg if giving tPA, below 220/120 mmHg if not
·Start aspirin 325 mg within 24 to 48 hours (but NOT within 24 hours of tPA)

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NCLEX trap

·Activate the stroke team the moment you suspect stroke, before imaging. The CT scan rules out bleeding so we know it is safe to give clot medicine, but the clock starts now. In stroke, every minute you wait kills about 2 million brain cells. Call the alert first, scan second.
·IV alteplase (the clot-dissolving medicine) only works safely within 4.5 hours of when the patient was last known normal. After that window, the risk of dangerous brain bleeding is too high to give it. You must know the exact time they were last okay, not when symptoms were noticed. If they woke up with stroke symptoms, the clock started when they went to bed.
·Low blood sugar (hypoglycemia), complex migraine with aura, seizure (either during or after, called Todd's paralysis), and Bell's palsy (which only affects the face, not the arm or leg) can all look exactly like stroke. Always check blood sugar first because fixing it takes 5 minutes and reverses the symptoms completely. Never assume stroke until mimics are ruled out.
·Alteplase dissolves clots, but it also raises the risk of bleeding inside the brain (intracerebral bleeding (hemorrhage)). You must watch the patient closely for the next 24 hours for new or worse weakness, sudden severe headache, confusion, nausea, vomiting, or a drop in consciousness. Brain bleeding after stroke treatment can be just as deadly as the stroke itself.
·Mild stroke symptoms right now can explode into severe stroke in the next hour. The clot can grow bigger or break off and travel to block a larger artery. Every stroke, no matter how mild it looks, deserves the same urgent stroke-alert response because brain tissue is dying every minute. Treat the clock, not just how bad it looks.
·Thrombectomy is excellent for large clots in large arteries (like the middle cerebral artery or internal carotid artery) and has a 24-hour window, but IV alteplase works faster for smaller clots and can be given at any hospital. Many patients get both treatments. Use imaging (CT angiography or CTA) to see clot size and location, then match the treatment to what you find.

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