You have just been called to the emergency department to evaluate and treat a possible stroke patient. You ask yourself: What should I do first? How do I know it is a stroke? Is it too late to reverse the damage, and if not, how do I do it? How do I make sure that I do things correctly during the first day or so to prevent worsening? This handbook is designed to answer these real-life questions. As new and effective stroke treatments are now available, and the creation of designated stroke centers for optimal care of stroke patients is endorsed and put into practice, there is a need for a guidebook that will help enlarge and inform the group of healthcare professionals responsible for delivering this care.

The handbook has been compiled from the day-to-day experiences of the Stroke Team at the University of Texas Medical School – Houston in caring for acute stroke patients on a dedicated in-patient stroke service. It describes the options and underlying rationale for making treatment decisions for stroke patients in the emergency department, stroke unit, neurological critical care unit, and pre-rehabilitation setting. It is evidence-based where evidence exists, but much of what is included reflects our best interpretation of what should be done in the absence of conclusive data.

It is intended as a practical guide to be used by medical students, house officers, and other clinicians with first-hand responsibility for the “nuts and bolts” care of these patients.