Treatment windows for stroke are timed from the moment the patient was last seen normal, not from when the symptoms were noticed. Someone who wakes with a weakness, or is found on the floor, was last known well when they went to bed or were last seen.
Record that time precisely, with who saw them and doing what. A vague history either sends an eligible patient home untreated or exposes an ineligible one to risk. With imaging-based selection now extending some windows well beyond 24 hours, a late presentation is a reason to ask the stroke team, not to assume nothing can be done.
- Ask who last saw the patient normal, when, and what they were doing.
- For wake-up stroke, last known well is when the patient went to sleep or was last seen.
- Document the time and its source in the notes.
- Contact the stroke team even for late presentations; imaging can still select patients for treatment.
Why it matters
The single most decisive fact in acute stroke is often the one taken least carefully.
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