Time is brain: door-to-imaging in minutes, and the treatment window counts from when last seen well.
Intracranial hemorrhage
No anticoagulants and no lysis before imaging — ever.
Large-vessel occlusion
Sudden severe deficit — a thrombectomy candidate at a capable centre.
Hypoglycemia mimicking stroke
Check glucose before activating the stroke pathway.
Document the deficit with a brief NIHSS — it changes transfer decisions.
Wake-up stroke? Do not exclude therapy — some centres use advanced imaging windows.
FAST positive = stroke alert and transport to the nearest capable centre with onset time and a witness phone number.
Correct it and the deficit resolves.
Gradual march, similar history, subsequent headache.
Witnessed seizure then improving deficit.
Thunderclap headache, neck stiffness.
Warning
No aspirin, no heparin, no lysis before imaging excludes hemorrhage. This rule has no exceptions.
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This content is an educational reference and does not replace clinical judgement or local protocols.
