DIAGNOSIS OF ISCHEMIC STROKE: CHALLENGES IN EMERGENCY PRACTICE

Abstract

Ischemic Stroke (IS) is one of the main causes of mortality and disability in Brazil and worldwide, representing a diagnostic and therapeutic challenge in urgent and emergency practice. Effective management depends on the rapid identification of symptoms, accurate differential diagnosis, and immediate initiation of reperfusion therapies, which often face barriers such as inequalities in access to specialized services and delays in care. This review article aims to consolidate knowledge on the challenges in diagnosing IS, focusing on neuroimaging tools, differential diagnosis with "stroke mimics", and acute therapies. The methodology consisted of curating clinical guidelines, systematic reviews, and randomized clinical trials. Non-contrast Computed Tomography (CT) is the first-choice examination in the emergency setting to exclude hemorrhage, a prerequisite for intravenous thrombolysis. However, CT may be normal in the early stages, and differentiation from conditions such as seizures, migraines, and metabolic disorders remains a clinical challenge. Therapies like thrombolysis with alteplase or tenecteplase and mechanical thrombectomy are time-dependent and have revolutionized prognosis, but their access is limited. Advances such as telemedicine and Artificial Intelligence emerge as opportunities to overcome geographical barriers and optimize image interpretation, speeding up decision-making. In conclusion, overcoming the challenges in acute IS management requires the implementation of guidelines adapted to local realities, investment in continuing education, and the strategic use of technologies to ensure equitable and efficient care.