The Code Stroke Handbook: Approach to the Acute Stroke Patient

A 65-year-old patient arrives at the Emergency Department with stroke symptoms that began 45 minutes ago. You are called STAT!Acute stroke management has changed dramatically in recent years. Tremendous advances have been made in acute treatments, diagnostic neuroimaging, and organized systems of care, and are enabling better outcomes for patients. Stroke has evolved from a largely untreatable condition in the acute phase to a true medical emergency that is potentially treatable―and sometimes curable. The Code Stroke emergency response refers to a coordinated team-based approach to stroke patient care that requires rapid and accurate assessment, diagnosis, and treatment in an effort to save the brain and minimize permanent damage.The Code Stroke Handbook contains the "essentials" of acute stroke to help clinicians provide best practice patient care. Designed to assist frontline physicians, nurses, paramedics, and medical learners at different levels of training, this book highlights clinical pearls and pitfalls, guideline recommendations, and other high-yield information not readily available in standard textbooks. It is filled with practical tips to prepare you for the next stroke emergency and reduce the anxiety you may feel when the Code Stroke pager rings.

• An easy-to-read, practical, clinical resource spread over 12 chapters covering the basics of code stroke consultations: history-taking, stroke mimics, neurological examination, acute stroke imaging (non-contrast CT/CT angiography/CT perfusion), and treatment (thrombolysis and endovascular therapy)
• Includes clinical pearls and pitfalls, neuroanatomy diagrams, and stroke syndromes, presented in an easily digestible format and book size that is convenient to carry around for quick reference when on-call at the hospital
• Provides foundational knowledge for medical students and residents before starting your neurology, emergency medicine, or internal medicine rotations

Dr. Micieli completed his undergraduate degree and Business Master’s degree at the University of Toronto. He completed his medical school training at the University of Ottawa, and is currently a senior adult neurology resident at the University of Toronto. His research focuses on decision analytic models to evaluate the cost-effectiveness of health technologies, specifically in atrial fibrillation and intracranial hemorrhage. He is an aspiring stroke neurologist, and will be completing his stroke fellowship at the prestigious Calgary Stroke Program.

Dr. Joundi received his MD from Queen’s University and DPhil from Oxford University on a Rhodes Scholarship. He was co-chief neurology resident at the University of Toronto and is pursuing a stroke fellowship at the University of Calgary.

Dr. Khosravani is appointed as a Clinician in Quality & Innovation and Assistant Professor of Medicine, in the Division of Neurology, Department of Medicine, University of Toronto. His interests are quality improvement at different levels of care relevant to hyper-acute stroke management and inpatient stroke services. At the level of hyperacute stroke care, his focus is on improvement of door-to-needle times for thrombolysis. He is also working on understanding and improving factors that are relevant to a successful thrombectomy program in a comprehensive stroke center. He is medical director of the inpatient stroke unit, and interested in development of stroke pathways, the overlap between internal medicine and inpatient stroke neurology, and development of a framework for excellence in comprehensive neurovascular care. Dr. Khosravani is a member of Thrombosis Canada and interested in the implementation of stroke-best practices in the area of antithrombotics and anticoagulation. Dr. Khosravani also has a strong interest in utilizing computation and computer science to facilitate safe and high quality acute stroke care.

Dr. Hopyan is a stroke neurologist and Co-Director of the NeuroDoppler Laboratory at Sunnybrook Health Sciences Centre. She is also a clinician teacher with the University of Toronto and is actively engaged in undergraduate and postgraduate teaching as well as curriculum development in the field of stroke neurology. She runs a busy clinical practice and has interests in neurosonology and large vessel disease.

Dr. Gladstone is a stroke neurologist and Associate Professor of Medicine at the University of Toronto. Since 2004, his practice has been based at Toronto’s Sunnybrook Health Science Centre, a designated provincial Regional Stroke Centre, where he specializes in stroke diagnosis, emergency stroke treatment, and stroke prevention. As a clinician, Dr. Gladstone is regularly seen rushing into the hospital in the middle of the night to provide emergency consultations as part of the hospital’s “Code Stroke Team” and for the Ontario Telemedicine Network’s provincial Telestroke program. As a researcher, he leads clinical trials aimed at improving stroke management and outcomes. As a teacher, Dr. Gladstone enjoys training medical students, residents, international fellows, and other healthcare providers on best practices in stroke care.