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Acute Stroke Evaluation

Recognize stroke syndromes quickly, apply the NIHSS accurately, and work through thrombolytic and thrombectomy decision-making with a clear framework.

What this track covers

This track covers the early recognition and workup of suspected acute stroke, from prehospital notification through NIHSS scoring, noncontrast CT interpretation, and eligibility screening for thrombolytics and mechanical thrombectomy. It also addresses post-thrombolytic monitoring and recognition of complications such as hemorrhagic transformation.

What you will practice

  • Recognizing common stroke syndromes and triggering rapid workup
  • Establishing last known well and reconciling conflicting timelines
  • Scoring the NIHSS consistently across exam elements
  • Screening a patient against thrombolytic inclusion and exclusion criteria
  • Identifying large vessel occlusion patterns that warrant thrombectomy evaluation

Simulator scenario

A patient presenting with acute-onset unilateral weakness and slurred speech of uncertain onset time, requiring rapid history-gathering, NIHSS scoring, and a treatment eligibility decision under time pressure.

Board question topics

  • NIHSS scoring nuances and inter-rater pitfalls
  • Thrombolytic inclusion and exclusion criteria
  • Noncontrast CT findings in early ischemia and hemorrhage
  • Recognizing and managing post-thrombolytic hemorrhagic transformation

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