Date Published

March 13, 2023

Updated For

ALS PCS Version ALS PCS Version 5.2


I have a scenario that happened and would like to know what the right answer is. We had a patient feeling generally unwell and dizzy. I performed a stroke assessment and he had equal grip strength, no pronator drift, and could raise both of his legs. There was no facial droop, slurred speech, or unilateral weakness. When we were transporting we noticed the patient was severely leaning to the right. He couldnt support himself upright at all, but everything else remained intact. Is this enough evidence to count as unilateral weakness? Would you stroke bypass?


This question regarding a patient who does not quite meet the Stroke Bypass criteria has been asked twice this month!

It sounds like you completed a very thorough and appropriate physical exam. Importantly paying special attention to unilateral upper and/or lower extremity weakness and drift AND re-assessing the patient en-route. If the patient does not meet these nor any of the other Stroke Bypass criteria, then the patient should be transported to the closest ED and not the stroke centre.



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