Clinical Notes : Neurology

24. Acute stroke and TIA

Diagnosis of Acute Stroke or Transient Ischaemic Attack

  • Detailed history suggestive of TIA

  • Detailed history suggestive of stroke

  • Subtle signs of stroke

    • Unable to walk or stand unaided (stroke)

    • Sustained significant headache (cerebellar hemorrhage)

    • Sustained significant neck pain (vertebral artery dissection)

  • Obvious signs of stroke

    • FAST assessment (Face, Arms, Speech, Time)

      • 78% predictive in anterior stroke

      • 60% predictive in posterior circulation stroke

  • Exclude condition mimicking stroke (in presence of obvious signs of stroke)

    • Rosier stroke recognition score >/= 0

  • Assess stroke risk if TIA (in presence of obvious signs of stroke)

    • ABCD2 score

      • Exclude posterior circulation stroke presenting as Acute Vestibular Syndrome

        • HINTS testing (see AVS notes)

 

History suggestive of TIA

Patients often dismiss symptoms of TIA as a ‘funny turn’, but 10% go on to have a stroke in the next 7 days.

 

The most common symptoms of a TIA are:

  • vision changes

  • trouble speaking

  • confusion

  • balance issues

  • numbness

  • weakness

  • tingling

  • muscular weakness generally on one side of the body

 

A TIA may also cause:

  • an altered level of consciousness

  • dizziness

  • passing out

  • an abnormal sense of taste

  • an abnormal sense of smell

  • weakness or numbness on just one side of the body or face

Conditions that mimic stroke

  • Seizure (commonest mimic)

  • Sepsis

  • Space occupying lesion

  • Syncope

  • Delirium

  • Vestibular

  • Migraine

 
 

F.A.S.T. assessment

 

Rosier stroke recognition score

 

Stroke is likely if total scores are > 0.

Scores of </= 0 have a low possibility of stroke but not completely excluded.

If BM < 3.5 mmol/l treat urgently and reassess once blood glucose normal

 

ABCD2 score for stroke risk in TIA

Low risk < 4 (7 day CVA risk 1.2%)

Mod risk 4-5 ( 7 day CVA risk 6%)

High risk > 5

Immediate management of stroke and TIA

  • check for hypoglycaemia and treat

  • arrange emergency admission

  • DO NOT GIVE ASPIRIN (as hopefully will have thrombolysis in hospital)

 
 

Stroke and transient ischaemic attack in over 16s: diagnosis and initial management

NICE Clinical Guidance CG68

March 2017

Access

 

2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Stroke. Vol49 No.3

January 2018

Access

Stroke Recommendations

JBS3 Joint British Societies for the Prevention of Cardiovascular Disease

Accessed online May 2015

Access

 

Is it a stroke?

Graeme J Hankey, David J Blacker

BMJ 2015;350:h56.

November 2014.

Access

Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials

Prof Peter M Rothwell, Prof Ale Algra, Prof Zhengming Chen, Prof Hans-Christoph Diener, ,

Prof Bo Norrving, Ziyah Mehta,

The Lancet. Volume 388, No. 10042, p365–375.

May 2016

Access

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