Suspected Stroke Clinical Pathway – Emergency Department – Stroke, Suspected

Suspected Stroke Clinical Pathway – Emergency Department and PICU

Signs and Symptoms of Childhood Stroke Syndromes

Acute Arterial Ischemic Stroke or TIA

Medical Description Lay Description Comment
Hemiparesis Weak arm or leg, facial droop, paralyzed on one side Combination of face with arm or face, arm and leg strongly suspicious for stroke
Aphasia Stopped speaking, talking nonsense, won’t follow commands Sometimes mistaken for confusion or oppositional behavior
Visual Field Cut Loss of vision, can’t see right Often causes gaze preference toward the side of intact vision, away from the hemiparetic side
Ataxia Unsteady gait, can’t walk straight, seems drunk, can’t sit steady, uncoordinated reach/grasp Often associated with headache, complaint of
dizziness, vomiting
Dysarthria (slurred speech) Speech is slurred, though word choice and comprehension are correct  
Hemisensory Loss Numbness, tingling on one side of body Usually involves one side of body and more than one body region (face+arm or face+arm+leg)
New-Onset Focal Seizures with Atypical Prolonged (> 1 hr) Post-Ictal Deficit   No previous dx of epilepsy now has several focal seizures followed by persisting weakness in location of the seizure (usually face+arm or face+arm+leg)

Acute Cerebral Sinovenous Thrombosis

Medical Description Lay Description Comment
Triad of unremitting and escalating headache, repeated vomiting and decreased mental status Lethargic, vomiting, irritable, headache Frequently has 6th nerve palsy and papilledema

Hemorrhagic Stroke
Intraventricular (IVH), Subarachnoid (SAH), Intracerebral/Intraparenchymal (ICH/IPH)

Medical Description Lay Description Comment
Hyperacute Severe Headache "Worst headache of my life" Often quickly followed by decreased mental status
Sudden Sustained Loss
of Consciousness		 "Collapsed," can't awaken Often preceded by headache, vomiting and/or seizure
One or Both of Above
with New Focal Deficit		 Paralyzed on one side, eyes going to one side, face drooping  

Developed by CHOP Stroke Team for screening and triage by nursing staff and emergency medicine providers.
Rev 01.18.06