The public, and even some health care providers, have long believed that stroke is a hopeless disease and that emergency identification (Table 1) and intervention will not make an important difference in patient outcome. This belief is certainly no longer true. In the past decade, advances in stroke care have led to a new understanding of the pathophysiology and natural history of cerebral vascular accidents. These insights have generated a host of recent stroke interventions such as thrombolysis, invasive vascular maneuvers, and the use of neuroprotective agents. 1 Bratina P Rapp K Barch C Kongable G Donnarumma R Spilker J et al. Pathophysiology and mechanisms of acute ischemic stroke. The NINDS rt-PA Stroke Study Group. J Neurosci Nurs. 1997; 29: 356-360 Crossref PubMed Scopus (3) Google Scholar , 2 Ringer A Qureshi A Fessler R Guterman L Hopkins L Angioplasty of intracranial occlusion resistant to thrombolysis in acute ischemic stroke. Neurosurgery. 2001; 48: 1282-1288 PubMed Google Scholar , 3 Rapp K Bratina P Barch C Braimah J Daley S Donnarumma R et al. Code stroke: rapid transport, triage and treatment using rt-PA therapy. The NINDS rt-PA Stroke Study Group. J Neurosci Nurs. 1997; 29: 361-366 Crossref PubMed Scopus (19) Google Scholar , 4 Blank F Keyes M Thrombolytic therapy for patients with acute stroke in the ED setting. J Emerg Nurs. 2000; 26: 24-30 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar , 5 Lutsep H Clark W An update of neuroprotectants in clinical development for acute stroke. Curr Opin Investig Drugs. 2001; 2: 1732-1736 PubMed Google Scholar Just as it is possible to intervene and limit myocardial damage following a heart attack, minimization and reversal of brain attack is becoming standard therapy. 6 Bonnono C Criddle L Acute ischemic stroke Emergi-path. J Emerg Nurs. 2000; 26: 340-342 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar However, new and aggressive evaluation strategies are required if health care professionals are to deliver thrombolytics and other interventions to patients who have sustained a stroke within the short window of time that starts at symptom onset (Table 2). TABLE 1Acute stroke signs and symptoms Sudden: •Numbness or weakness of the face, arm, or leg, especially on one side of the body (paralysis, paraesthesias) •Confusion, trouble speaking or understanding (dysarthria, aphasia) •Trouble seeing in one or both eyes (diplopia, monocular blindness) •Trouble walking, dizziness, loss of balance or coordination (ataxia) •Severe headache with no known cause Open table in a new tab TABLE 2Identifying potential candidates for thrombolytic therapy following acute ischemic stroke •Tissue plasminogen activator (rt-PA) is currently the only treatment proven to decrease the size and severity of ischemic stroke and improve functional outcome •rt-PA must be administered within 3 hours of symptom onset •Determining the last known time the patient was at baseline, or deficit free and awake, is crucial •If the precise time of onset cannot be determined with certainty (eg, when a patient awakens with a deficit or is unable to communicate), the last time the patient was known to be well is considered the onset time Reprinted from Blank F, Keyes M. Thrombolytic therapy for patients with acute stroke in the ED setting. J Emerg Nurs 2000;26:24-30. Open table in a new tab Reprinted from Blank F, Keyes M. Thrombolytic therapy for patients with acute stroke in the ED setting. J Emerg Nurs 2000;26:24-30.