Brain attack should be tackled like a heart attack. As time is brain, a patient with suspected paralysis/stroke or brain attack should be shifted to hospital at the earliest and given a clot dissolving therapy if the CT scan is negative for brain hemorrhage. Prevention for paralysis is the same as prevention for heart attack. All patients with paralysis should undergo testing for underlying heart disease and all patients with heart diseases should undergo testing to detect blockages in the neck artery which can cause future paralysis.


• One should rule out brain hemorrhage as soon as possible.

• Obtain emergent brain imaging (with CT or MRI) and other important laboratory studies, including cardiac monitoring during the first 24 hours after the onset of ischemic stroke.

• Check glucose and correct high or low sugar. If the blood sugar is over 180 mg/dL, start insulin.

• Maintain normothermia for at least the first several days after an acute stroke.

• For patients with acute ischemic stroke who are not treated with thrombolytic therapy, treat high blood pressure only if the hypertension is extreme (systolic blood pressure >220 mmHg or diastolic blood pressure >120 mmHg), or if the patient has another clear indication (active ischemic coronary disease, heart failure, aortic dissection, hypertensive encephalopathy, acute renal failure, or pre–eclampsia/eclampsia).

• For patients with acute ischemic stroke who will receive thrombolytic therapy, antihypertensive treatment is recommended so that systolic blood pressure is ≤185 mmHg and diastolic blood pressure is ≤110 mmHg.

• Antithrombotic therapy should be initiated within 48 hours of stroke onset.

• For patients receiving statin therapy prior to stroke onset it should be continued.

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