Patient Management Recommendations

• Level A recommendations: None specified.
• Level B recommendations: Use either tenecteplase or alteplase in patients with acute ischemic stroke who qualify for thrombolysis.*
• Level C recommendations: None specified.

*For tenecteplase, use 0.25 mg/kg maximum dose 25 mg bolus; for alteplase, use 0.9 mg/kg maximum dose 90 mg with 10 percent given as a bolus and the remaining as an infusion over 60 minutes.

Question 4: In adult patients who present with acute vertigo with possible stroke, is there a history or physical examination findings (e.g., HINTS examination) that can risk stratify for acute ischemic stroke?

Patient Management Recommendations

• Level A recommendations: None specified.
• Level B recommendations: None specified.
• Level C recommendations: In addition to a standard comprehensive history and physical examination, physicians may use specific findings such as ABCD2 score, ocular motor examination, presence of additional neurologic deficits, and HINTS to risk stratify patients with a possible stroke. Before employing a maneuver such as HINTS, physicians should have sufficient education to perform the technique (Consensus recommendation).

Dr. Lo is chief of the department of emergency medicine in Sentara Hospitals Norfolk and medical director of Sentara Transfer Center as well as professor/assistant program director Eastern Virginia Medical School in Norfolk, VA.