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. 2022 Contents Overview 5 Who is it for? 5 1.1 Rapid recognition of symptoms and diagnosis 6 1.2 Imaging for people who have had a suspected TIA or acute non-disabling stroke 7 1.3 Specialist care for people with acute stroke 9 1.4 Pharmacological treatments and thrombectomy for people with acute stroke 10 1.5 Maintenance or restoration of homeostasis 15 1.6 Nutrition and hydration 17 1.7 Optimal positioning and early mobilisation for people with acute stroke 19 1.8 Avoiding aspiration pneumonia 20 1.9 Surgery for people with acute stroke 20 Terms used in this guideline 22 Additional information 23 Recommendations for research 25 Key recommendations for research 25 Rationale and impact 29 Initial management of suspected and confirmed transient ischaemic attack (aspirin) 29 Initial management of suspected and confirmed transient ischaemic attack 30 Imaging for people who have had a suspected TIA or acute non-disabling stroke 31 Thrombectomy for people with acute ischaemic stroke 33 Blood pressure control for people with acute intracerebral haemorrhage 36 2022 Optimal positioning for people with acute stroke 39 Early mobilisation for people with acute stroke 40 Decompressive hemicraniectomy for people with acute stroke 41 Finding more information and resources 45 Update information 46 2022 This guideline replaces CG68. This guideline is the basis of QS2. Overview 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. 