• Stroke (sudden onset of rapidly developing focal or global neurological disturbance which lasts >24 hours or leads to death)

• Transient Ischaemic Attack (TIA) (<24 hours neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without evidence of acute infarction): Stroke and TIA (CKS), Cerebrovascular disease (NHS Choices), Stroke (NHS Choices)​, Transient Ischaemic Attack (TIA) (NHS Choices)

• Subarachnoid haemorrhage: Subarachnoid haemorrhage (NHS Choices), Brain aneurysm (NHS Choices)

• Vascular dementia: Vascular dementia (NHS Choices)

Current guidance states that thrombolysis with alteplase is recommended for treating acute ischaemic stroke in adults as soon as possible within four-and-a-half hours of onset of stroke symptoms. Treatment is indicated after exclusion of intracranial haemorrhage. A clear time of onset is essential.

Contraindications for alteplase include a stroke in the last three months or a convulsion-accompanying stroke.

Resource:

• NICE. Stroke and Transient Ischaemic Attack in over 16s: diagnosis and initial management. NG128. 2019 (updated 2022).