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Specifics about each Level and each Item:
What you do you need to know:
Level 1
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Recognizes when a patient may have a Cerebrovascular
disorder
Clinical presentations of
acute cerebrovascular events
cerebral infarction
transient ischemic attack
intracerebral hemorrhage
subarachnoid hemorrhage
Distinguishes the common
Stroke mimics
hypoglycemia
seizure with post-ictal Todd’s paralysis
migraine with aura
psychogenic conversion disorder
Level 2
• Describes
stroke syndromes and etiologic subtypes
Stroke syndromes
Middle cerebral artery occlusion: anterior division,
posterior division
Carotid artery embolism
Top of the Basilar syndrome
Lacunar syndromes- pure motor hemiparesis, pure sensory
syndrome, ataxic hemiparesis
Basal ganglia intracerebral hemorrhage
Etiologic subtypes
TOAST Ischemic stroke subtypes- Large artery
atherosclerosis, small vessel / lacunar disease,
cardioembolism
Cervicocephalic dissection
Hypertensive-type intracerebral hemorrhage
Intracerebral hemorrhage with amyloid angiopathy
• Identifies
Cerebrovascular emergencies
Aneurysmal subarachnoid
hemorrhage
Intracerebral hemorrhage with cerebral edema, brain
compression
Symptomatic carotid artery stenosis
Cerebellar infarction
• Lists
indications and contraindications for intravenous
thrombolytic therapy
Criteria for IVtPA within 3
hours of stroke symptom onset
Criteria for expanded window IVtPA, 3-4.5 hours from
stroke symptom onset
Level 3
• Identifies
specific mechanism of patient’s Cerebrovascular disorder
Requests and interprets
vascular imaging - MRA, CTA, carotid duplex ultrasound
Requests and interprets cardiac evaluations- TTE, TEE,
telemetry, prolonged cardiac monitoring
•
Appropriately refers for interventional or surgical
evaluation
Symptomatic severe carotid
atherostenosis
Saccular intracranial aneurysm
Major ischemic stroke within 8 hours of stroke symptom
onset for evaluation of potential endovascular
revascularization therapy
• Manages
common Cerebrovascular disorders including appropriate
use of thrombolytics
Employs best practices for
stroke (Get with the Guidelines / Joint Commission/
Meaningful Use criteria)
Antithrombotic therapy on admission and discharge for
ischemic stroke or TIA
Statin therapy for hyperlipidemia after ischemic stroke
or TIA
DVT prophylaxis on admission
Anticoagulation for stroke prevention with atrial
fibrillation, when appropriate
Assessment for Rehabilitation needs after ischemic and
hemorrhagic stroke
Stroke education after ischemic and hemorrhagic stroke
Understands post-thrombolytic protocol and manages blood
pressure per protocol
Level 4
•
Diagnoses uncommon Cerebrovascular disorders
Reversible constrictive
vasculopathy syndrome
Cerebral venous thrombosis
Antiphospholipid syndrome
Level 5
• Manages
uncommon Cerebrovascular disorders
Septic embolism
Cerebral vasculitis
Mitochondrial encephalopathy
• Engages in
scholarly activity in Cerebrovascular disorders
Conducts and presents an
original, collaborative research project at a local,
regional, or national meeting
Develops educational curriculum and presents to staff
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