StrokeRefer

• Ischaemic (CT: no bleed): Alteplase (disabling deficit, within 4.5 h), Tenecteplase (disabling deficit, within 4.5 h), Aspirin (not within 24 h of lysis), Clopidogrel + Aspirin (non-disabling stroke NIHSS 5 or less, or high-risk TIA; start within 24–72 h), Atorvastatin
• Intracerebral bleed: Labetalol IV (target SBP 130–150, about 140)
• Subarachnoid haemorrhage: Nimodipine

• Thrombectomy: Refer at once — benefit up to 24 h in selected patients; after it, do not push systolic below 140 (AHA/ASA 2026)

Time is brain: CT first — do not delay imaging for blood results other than glucose.

First visit

• Capillary blood glucose — Exclude hypoglycaemia mimicking stroke.
• Non-contrast CT brain — At once: bleed vs infarct, before any lysis.
• CBC, PT/INR, APTT, creatinine — Before thrombolysis or anticoagulation.
• ECG — Atrial fibrillation.

Only if indicated

• CT angiography — Within 24 h of onset — large vessel occlusion (thrombectomy).
• MRI brain — Uncertain diagnosis or posterior circulation stroke.
• Carotid Doppler, echo, lipid profile, HbA1c — Secondary prevention work-up.
• Holter monitoring — Cryptogenic stroke (paroxysmal AF).