Management of Cerebrovascular Accident (CVA)

Immediate Management

The American Heart Association recommends immediate management of a patient with suspected CVA should follow published guidelines for emergency stroke care, including rapid assessment, stabilization, thrombolytic therapy for eligible patients, and implementation of initial preventive therapy 1
Document onset time and duration of symptoms, as recommended by the American Heart Association 1
Record specific neurological deficits reported by patient or witnesses, as recommended by the American Heart Association 1
Note risk factors: hypertension, diabetes, hyperlipidemia, smoking, atrial fibrillation, as recommended by the American College of Cardiology 2
Document previous stroke or TIA history, as recommended by the American Heart Association and the American College of Cardiology 1, 3

Specify stroke type: ischemic (embolic, thrombotic, lacunar) or hemorrhagic, as recommended by the American College of Cardiology 2
Identify vascular territory affected, as recommended by the American Heart Association 1
Assess stroke severity using standardized scale, as recommended by the American College of Cardiology 2
Determine time of onset for treatment window considerations, as recommended by the American Heart Association 1
Evaluate for stroke mimics (e.g., seizures, migraine, hypoglycemia), although specific recommendations are not provided by cited sources

Administer intravenous thrombolysis (tPA) if within appropriate time window (typically 3-4.5 hours) and no contraindications, as recommended by the American College of Cardiology 2
Consider mechanical thrombectomy for large vessel occlusion if within appropriate time window, as recommended by the American College of Cardiology 2
Maintain blood pressure <180/105 mmHg if thrombolysis administered, as recommended by the American College of Cardiology and Anaesthesia 2, 5
Control systemic hypertension with goal systolic BP 130-150 mmHg for hemorrhagic stroke, as recommended by the American College of Cardiology 2
Reverse anticoagulation if applicable for hemorrhagic stroke, as recommended by the American College of Cardiology 2

Initiate statin therapy regardless of baseline cholesterol, as recommended by the American College of Cardiology 2
Start antihypertensive therapy after acute phase (typically 24-48 hours post-stroke), as recommended by the American College of Cardiology 2
Consider anticoagulation for atrial fibrillation after ruling out hemorrhagic transformation, as recommended by the American College of Cardiology 2
For symptomatic carotid stenosis >70%, consider carotid endarterectomy within 2 weeks, as recommended by the American Heart Association and the American College of Cardiology 1, 3

Begin early mobilization when medically stable, as recommended by the American College of Cardiology 2
Initiate physical, occupational, and speech therapy assessments, although specific recommendations are not provided by cited sources
Address specific deficits: motor, sensory, language, cognitive, visual, as recommended by the American College of Cardiology 4
Assess need for rehabilitation facility versus home with services, as recommended by the American College of Cardiology 2
Provide education on stroke warning signs and risk factor modification, as recommended by the American Heart Association 1