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Project: Ghana Emergency Medicine Collaborative
Document Title: Stroke Management in the 21st Century: What Do You
Need to Know?
Author(s): Rashmi Kothari (Michigan State University), MD 2012
License: Unless otherwise noted, this material is made available under the
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We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability
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For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use.
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Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.

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Reference: Tissue Plasminogen Activator for Acute Ischemic Stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group5
N Engl J Med 1995; 333:1581-1588. http://www.nejm.org/doi/full/10.1056/NEJM199512143332401.
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Kothari Stroke 1997;28

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Shantoo, Wikimedia Commons

Facial Droop
Normal:
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Gonad, Wikimedia Commons

Normal:
Abnormal:
St Bartholomew's Hospital Archives &
Museum, Wellcome Images

Normal:
Abnormal:

Both sides of face move equally
One side of face does not move at all

Arm Drift
Both arms move equally or not at all
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Speech
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12
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14
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20

Placebo

rt-PA

31
0

10

20

30

Number of Patients
((N Engl J Med 1995:333)

40

30
A@d$G(*."/$*5%$?&+.*43.#$
Placebo 0.3

21
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Mortality

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17

5

10

15

20

25

Number of Patients
(N Engl J Med 1995:333)

31
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Percentage of t-PA Patients with Symptomatic ICH
18
16
14
12
10
8
6
4
2
0

17

2
0-5

3
6-10

5

4

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Baseline NIH Stroke Scale Score
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32
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LOS

rt-PA
Placebo
n=312
n=312
p Value
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(mean days +SD)

Disposition

0.002*

Home

151 (48%)

112(36%)

Rehab unit

91 (29%)

115 (37%)

Nursing home 22 (7%)

39 (13%)

Dead

35 (11%)

40 (13%)

Other

13 (4%)

6 (2%)

Neurology 1998;50

* compared home to all other dispositions

33
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34
R*5%&>3l(%$F.+(M.&035*/($2+3*4/$
Study

Time to
Treat
228 <4 hrs

MAST-I

622 <6 hrs

Mortality

SK+ASA

NA

43%

NA

22%

SK

18%

35%

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MAST-E 270 <6 hrs

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ASA

ASK

N

3%

18%

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10%

34%

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6%

19%

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10%

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0.6%

13%

35

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