Acute Ischemic stroke (AIS) patients are frequently admitted to neuroscience intensive care unit (NICU) after receiving tissue plasminogen activator (TPA). AIS patients who are admitted to NICU undergoes frequent hourly neurological examinations to quickly detect neurological deterioration. The hourly neurological examination requires the patient to be awakened and cause disruption of the sleep-wake cycle. There is an association between poor sleep quality and delirium. Delirium increases the risk for mortality, morbidity, length of hospitalization, and institutionalization in patients with AIS.

We retrospectively chart reviewed patients admitted to our NICU with AIS after TPA during a two-year period. Delirium incidence during hospitalization was assessed through confusion assessment method for the ICU (CAM-ICU) scale. Antipsychotic medications for behavioral modification was assessed through medical administration record. Post thrombolytic neurological complications were studied by assessing the need for emergent head computed tomography during the first twenty-four hours.

The average national institute health stroke scale was 10.28. The average modified Rankin Scale at discharge was 2.08.  One patient out of sixty was diagnosed with delirium and was discharged home on antipsychotic medication. Two patients out of sixty had a post thrombolytic intracranial hemorrhage, however, this was not captured in the hourly neurological examination and was found on the next day post TPA head CT. 

Frequent neurological examinations are not associated with increased risk for delirium during the hospitalization in the AIS patients who received thrombolytic therapy. The study also did not find an increased incidence of prescription of antipsychotics secondary to delirium at discharge. Frequent hourly neurological examinations did not increase the detection of neurological deterioration. Further studies looking at stroke characteristics and patient comorbidities are needed to understand who will benefit the most from hourly neurological examination.