This guideline covers interventions in the acute stage of a stroke or transient ischaemic attack (TIA). It offers the best clinical advice on the diagnosis and acute management of stroke and TIA in the 48 hours after onset of symptoms.
In April 2022, we reviewed the evidence and made new recommendations on blood pressure control for people with acute intracerebral haemorrhage.
This guideline includes recommendations on:
- rapid recognition of symptoms and diagnosis, including initial management of suspected and confirmed TIA
- imaging for people with suspected TIA
- specialist care, pharmacological treatments and surgery for people with acute stroke
- thrombectomy for people with acute ischaemic stroke
- maintenance or restoration of homeostasis, including blood pressure control for people with acute intracerebral haemorrhage
- nutrition and hydration
- optimal positioning and early mobilisation for people with acute stroke
- decompressive hemicraniectomy for people with acute stroke
Who is it for?
- Healthcare professionals in primary and secondary NHS healthcare settings
- Commissioners and providers of services
- People aged over 16 who have had a stroke or TIA, their families and carers
Is this guideline up to date?
May 2023: We have found no new evidence that affects the recommendations. For more information, see the surveillance decision.
Guideline development process
This guideline updates and replaces NICE guideline CG68 (July 2008).
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.