Transcranial Direct Current Stimulation in Acute Ischemic Stroke Treatment

Prior treatment

• Presence of tDCS contraindications: skin lesion at the site of stimulation (open wound, acute inflammation of skin or subcutaneous tissue, burns etc.); skull defect at the site of stimulation (e.g. skull fracture, postcraniectomy); implanted electric device (pacemaker, ICD, DBS, cochlear implant etc.); presence of metal material in head (e.g. metal stent, clamps etc.).
• Concomitant experimental therapy.

Other illness

• Acute intracranial hemorrhage including suspected subarachnoid hemorrhage.
• Other than ischemic cause of acute neurological deficit (stroke mimics:postparoxysmal Todd´s palsy, metabolic cause, tumor, meningoencephalitis etc.).
• Intra-axial malignant brain tumor.
• History of spontaneous ICH in the past.
• History of seizure disorder or new seizures with presentation of current stroke.
• History of intracranial surgery.
• History of acute overdose by DOAC.
• Known congenital or acquired increased bleeding propensity.
• Known CT iodine contrast allergy.
• Signs or symptoms of acute myocardial infarction, including ECG findings, on admission.
• Evidence of any other major life-threatening or serious medical condition that would prevent completion of the study protocol including attendance at the 3-month follow-up visit.

Lab values

• INR \> 3,0.
• Heparin or LMWH therapy in last 48 hours with aPTT increased more than 1,5 times over limit of the laboratory.
• Known renal dysfunction (eGFR\<30 ml/min.).

Other

• Evidence of a large Ischemic core volume on baseline CTP: volume of rCBF\<30% ≥ 100ml.
• Subacute or chronic subdural hematoma or hygroma.
• Thrombocytopenia \< 100 000/ul.
• Suspected or confirmed pregnancy.
• Suspicion of aortic dissection on admission.

• Age \> 18 years.
• New focal neurologic deficit consistent with acute ischemic stroke.
• Baseline NIHSS ≥ 4 or NIHSS \< 4 in the presence of disabling deficits (e.g. aphasia)
• Presence of acute occlusion of ICA or MCA (including MCA peripheral cortical branches) according to clinical picture and baseline CTA/CTP scan.
• Presence of salvageable penumbra with Tmax \> 6 sec/ ischemic core volume (rCBF \< 30%) ≥ 1.2 on baseline CTP scan.
• Patient is ineligible for EVT per current national guidelines (Cerebrovascular Section of Czech Neurological Society ČLS JEP).
• Subject is able to be treated with tDCS within 24 hours of last known well time.
• A signed informed consent is obtained from the patient or patient's legally authorized representative (point 30 of Declaration of Helsinki).