To differentiate between tPA and non-tPA candidates see Thrombolysis in Acute<unk>  (tPA)
Prevent dehydration
Maintain SpO2 > 92%
Maintain blood glucose between 140 and 180 mg/dL
Prevent fever
HOB > 30°
tPA
See Thrombolysis in Acute<unk>  (tPA)
Hypertension
Lower SBP to < 185, DBP to < 110
Goal MAP < 130
Options:
Labetalol 10–20 mg IV over 1–2 min; may repeat x1 OR
Nitroglycerin paste, 1–2 in. to skin OR
Nicardipine 5 mg/hr, titrate up by 2.5 mg/hr at 5-15 min intervals; max dose 15 mg/hr
When desired blood pressure attained reduce to 3 mg/hr
See Thrombolysis in Acute<unk>  (tPA)
Lower SBP to < 185, DBP to < 110
Goal MAP < 130
Options:
Labetalol 10–20 mg IV over 1–2 min; may repeat x1 OR
Nitroglycerin paste, 1–2 in. to skin OR
Nicardipine 5 mg/hr, titrate up by 2.5 mg/hr at 5-15 min intervals; max dose 15 mg/hr
When desired blood pressure attained reduce to 3 mg/hr
Labetalol 10–20 mg IV over 1–2 min; may repeat x1 OR
Nitroglycerin paste, 1–2 in. to skin OR
Nicardipine 5 mg/hr, titrate up by 2.5 mg/hr at 5-15 min intervals; max dose 15 mg/hr
When desired blood pressure attained reduce to 3 mg/hr
When desired blood pressure attained reduce to 3 mg/hr
Hypertension
Allow permissive hypertension
If SBP > 220 or DBP > 120, lower by 25% over 24 hrs (drug of choice is nicardipine)
Goal MAP for non-thrombolyzed, MAP < 150, per AHA guidelines
Aspirin 325mg (within 24-48hr)
Clopidogrel 600 mg load (followed by 75 mg daily for 30-90 days)
prevents 15 strokes out of 1000 patients at a cost of 5 additional major noncerebral hemorrhages. 
Anticoagulation not recommended for acute stroke (even for A-fib)
Allow permissive hypertension
If SBP > 220 or DBP > 120, lower by 25% over 24 hrs (drug of choice is nicardipine)
Goal MAP for non-thrombolyzed, MAP < 150, per AHA guidelines
prevents 15 strokes out of 1000 patients at a cost of 5 additional major noncerebral hemorrhages. 
Mechanical clot removal for large vessel occlusions (e.g. M1 occlusion, basilar artery occlusion)
Early trials MR RESCUE, SYNTHESIS, and IMSIII showed no benefit and potential harm
MR CLEAN Trial show promising outcomes
Participants had proximal intracranial artery occlusions
Intervention was conducted within 6 hrs
Functional independence of 32.6% with endovascular treatment and 19.1% with typical therapy
AHA guidelines say the following patients are eligible for mechanical thrombectomy:
0-6 hours: pre-stroke mRS 01, ICA or M1 occlusion, age > 18, NIHSS > 5, puncture < 6 hours
0-6 hours: May also be reasonable in carefully selected patients with M2 or M3 occlusions
6-16 hours: anterior circulation LVO who meet DAWN or DEFUSE 3 criteria
16-24 hours: anterior circulation LVO who meet DAWN criteria
May require careful patient selection based on last known normal, ICA/prox MCA occlusion, and additional diagnostic studies such as CT perfusion study, Rapid MRI, etc
Goal SBP <160 after endovascular therapy 
Participants had proximal intracranial artery occlusions
Intervention was conducted within 6 hrs
Functional independence of 32.6% with endovascular treatment and 19.1% with typical therapy
0-6 hours: pre-stroke mRS 01, ICA or M1 occlusion, age > 18, NIHSS > 5, puncture < 6 hours
0-6 hours: May also be reasonable in carefully selected patients with M2 or M3 occlusions
6-16 hours: anterior circulation LVO who meet DAWN or DEFUSE 3 criteria
16-24 hours: anterior circulation LVO who meet DAWN criteria
Early neurosurgical consultation is needed (herniation may lead to rapid deterioration)
See Cerebellar Stroke
Cochrane review showed no benefit in mortality or functional outcomes
Ischemic stroke
Stroke
Hemorrhagic stroke
Seizures/postictal paralysis 
Subarachnoid hemorrhage
Syncope
Vertebral and carotid artery dissection
Subdural hemorrhage