Therapy

The benefits of thrombolysis are mixed ^a - it cannot currently be recommended as routine therapy. ^d  

Thrombolysis is applicable for patients who understand the risks ^d and

• present within 3 to 6 hours of symptom-onset ^c  with a clear neurological deficit ^d
• have a CT scan which excludes a haemorrhagic stroke ^a
• have neurological deficit that is neither very mild or very severe ^d
• have no recent trauma or surgery, ^d or no active peptic ulcer disease ^d

• calcium-channel blockers ^d  
• corticosteroids ^d  
• fibrinogen-depleting agents ^d  
• gangliosides ^d
• glycerol ^d  
• glycine antagonists ^d  
• haemodilution ^d  
• an integrated care pathway for patient management ^d  
• mannitol ^d  
• prostacyclin ^d  
• piracetam ^d  
• pentoxifylline, propentoflylline, pentifylline ^d  
• theophylline ^d  
• tinzaparin ^d  

Intracranial haemorrhage 

There is no clear benefit from haematoma evacuation ^d  

Depression

Give fluoxetine 20 mg daily ^a  

Consider inserting a polyurethane ^a percutaneous gastrostomy tube (PEG) if your patient has persistent dysphagia ^a unless there are ^c

• GI abnormalities 
• ascites or hepatomegaly 
• clotting disorders

Give antibiotic prophylaxis. ^a

There is no clear benefit from aggressive management by a dysphagia therapist ^d

There is no clear benefit from 

• speech and language therapy for apahasia  ^d
• pharmacotherapy for aphasia. ^d

Spasticity

Consider using

• baclofen ^a  
• botulinum toxin for spastic limbs ^a  
• acupuncture for patients with severe hemiparesis ^a  

There is no clear benefit from

• electromyographic biofeedback ^d
• sensorimotor stimulation ^d
• leg and arm training ^d
• spatiomotor cueing for visual neglect ^d
• functional electrostimulation ^d  
• cognitive rehabilitation for attention deficit ^d  

Discharge

Consider early supported discharge and community rehabilitation ^a with home physiotherapy ^a

family care workers ^d