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Definitions

2018 UPDATE
June 2018

Acute Stroke: An episode of symptomatic neurological dysfunction caused by focal brain, retinal or spinal cord ischemia or hemorrhage with evidence of acute infarction or hemorrhage on imaging (MR, CT, retinal photomicrographs), and regardless of symptomatic duration.

Transient Ischemic Attack (TIA): A brief episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia, with clinical symptoms and without imaging evidence of acute infarction. Transient ischemic attack and minor stroke are the mildest form of acute ischemic stroke in a continuum that cannot be differentiated by symptom duration alone, but the former typically resolves within one hour.

Prehospital and Emergency Department stroke care refers to the key interventions involved in the assessment, diagnosis, stabilization and treatment in the first hours after stroke onset. This represents all pre-hospital and initial emergency care for TIA, ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage and acute venous sinus thrombosis.  This stage involves rapid triaging of patients based on stroke acuity and brain imaging. Treatments may include acute intravenous thrombolysis or acute endovascular interventions for ischemic stroke, emergency neurosurgical procedures, and same-day TIA diagnostic and risk stratification evaluation.

The principal aim of this phase of care is to diagnose the stroke type, and to coordinate and execute an individualized treatment plan as rapidly as possible.

Prehospital and Emergency care is time-sensitive by nature, minutes for disabling stroke and hours for TIA, but specific interventions are associated with their own individual treatment windows. Broadly speaking, the ”hyperacute” time window refers to care offered in the first 24 hours after an acute stroke (ischemic and hemorrhagic) and the first 48 hours after a transient ischemic attack.

Acute stroke care refers to the key interventions involved in the assessment, treatment or management, and early recovery in the first days after stroke onset. This will represent all of the initial diagnostic procedures undertaken to identify the nature and mechanism of stroke, interdisciplinary care to prevent complications and promote early recovery, institution of an individualized secondary prevention plan, and engagement with the stroke survivor and family to assess and plan for transition to the next level of care (including a comprehensive assessment of rehabilitation needs). New models of acute ambulatory care such as rapid assessment TIA and minor stroke clinics or day-units are also starting to emerge.

The principal aims of this phase of care are to identify the nature and mechanism of stroke, prevent further stroke complications, promote early recovery, and (in the case of severest strokes) provide palliation or end-of-life care.

Broadly speaking “acute care” refers to the first days to weeks of inpatient treatment with stroke survivors transitioning from this level of care to either inpatient rehabilitation, community based rehabilitation services, home (with or without support services), continuing care, or palliative care. This acute phase of care is usually considered to have ended either at the time of acute stroke unit discharge or by 30 days of hospital admission.