Introduction

Thanks for the great review.

Does anyone fight the tPA fight anymore? One weak RCT to support its use.

Here’s a good summary of the literature:
https://emergencymedicinecases.com/thrombolysis-endovascular-therapy-for-stroke/

Any comments on Hypertensive Encephalopathy? This was not mentioned as a stroke mimic. Given the tremendous pressure now a days to meet metrics and do things as fast as possible, is it reasonable or unreasonable to watch and wait for your Labetalol or Cardene to resolve symptoms, and if so, what is that time frame.
At my facility, we are pushed for a door to needle time of <60min.
Just in the past 2 weeks I have had 2 different patients present with neurologic deficits consistent with having a stroke, but ended up with diagnosis of Hypertensive Encephalopathy.
There was talk of "not lowering the blood pressure" in certain cases. I disagree leaving BP high in the face of neurologic defecits if TPA is not going to be given.
TPA is not a benign drug and it seems that the stroke neurologists will give TPA on a whim if non-contrast head CT is negative and absence of contraindications, solely to meet the metric.