Acute stroke

These documents can be of use in the running of an acute stroke unit and in setting up thrombolysis service. Please click here for training in acute stroke clinical skills and CT interpretation.

West Midlands Ambulance Guidance for pre-alerting FAST positive stroke patients. Click here for a poster  illustrating triage via the FAST test. 

Stroke Pathway including SSNAP entry forms: a clinical pathway with triage for thrombolysis and clerking document for direct admission of stroke patients from A&E to the stroke unit.
--ASU 72 hour MDT pathway (part 3 of stroke pathway).
-TIA referral form
-TIA clinic patient information sheet  
-Carotid surgery referral 
-Cerebral angio protocol
-MRI safety procedures  in patients unable to answer the safety questions
-Image Exchange Portal for remote viewing of Scans (password needed)

Thrombolysis pathway for A&E: use this pathway to guide  therapeutic thrombolysis. Once thrombolysis has been performed print out the thrombolysis nurse care pathway for monitoring and further management. This must be started immediately and handed over to ward staff at the time of transfer. Complete SITS case record form and enter data on SITS website. Access this link for  NIHSS forms and instructions.

Emergency management of complications of thrombolysis: includes instructions for the management of intracranial haemorrhage, extracranial bleeding, orolingual angiooedema, anaphylaxis, hypertension, and reperfusion cerebral oedema.

Thrombolysis Training Folder: the nursing pathway for thrombolysis, instructions on how to diagnose and treat complications, advice on tricky CTs and FAQs. Click here for a link to the alteplase product characteristics (SMPC).

Endovascular treatments for stroke (e.g. intra-arterial thrombolysis and/or thrombectomy): this is should be considered in large MCA infarcts and in patients with vertebrobasilar artery occlusion. Please click links to access:
-Pathway
-Patient information leaflet
-Thrombectomy register data entry log
-Data entry file
-SITS data entry form to be completed by the neurointerventionalist
-Nurse pathway
-Thrombectomy protocol
-UK Consensus statement endovascular treatments for stroke

Please see NICE IPG458 for guidance of clinicians and NICE Information for the Public to be given to patients/relatives considering the procedure.   

Endovascular treatment database and audit collaboration
Data entry sheet (please contact christine.roffe@northstaffs.nhs.uk for password and further information).
EVT database (copy columns from data entry sheet here to produce local statistics).


Decompressive hemicrainectomy for malignant MCA Syndrome: in young patients with middle large middle cerebral artery infarcts there is a risk of severe fatal cerebral oedema. Please click here for a pathway for decompressive hemicraniectomy.


The SITS thrombolysis register All thrombolysed patients and those who had thrombectomies should be entered into this register to ensure continuing audit of outcome and complications. The case record form can be printed directly form this link. Participation will allow you to compare the results of your center with the rest of the UK and internationally. Other than the number of patients recruited, individual centre data are anonymised for all other users. Please click  here to enter a patient into the database, to register your hospital as a SITS centre and get a personal log in.


NICE guidance on Thrombolysis for stroke July 2007. Includes the full HTA appraisal, a summary document, information for patients and carers, as well as a costing template for the business case and recommendations for audit.

The North Staffordshire Stroke Manual: a guide for management of stroke patients from admission to discharge and follow-up aimed at all members of the multidisciplinary team. This is a growing and developing document. Please contact me if you would like to contribute, or if you would like to make corrections (big file 700 KB, takes up to 4 min to download on broadband).

The Post Stroke Checklist for long-term follow-up

Presentation: Developing a service for endovascular stroke treatment

Web presentation: Risks and benefits of thrombolysis

Web presentation: A short Guide to CT After Stroke

Web presentation: Management of Acute Stroke

Web presentation: Diagnosis of acute stroke

Web presentation: Alteplase pharmacology

Web presentation: Indications for thrombolysis

Web presentation: Complications of thrombolysis

Web presentation: Developing Acute Stroke Services

Web presentation: Safe Implementation of Thrombolysis in Stroke

Management of Malignant Middle Cerebral Artery Syndrome (Decompressive hemicraniectomy)

Intra-arterial thrombolysis

Local policies and files: ASU Draft Operational Policy 7 (2010)