ABC of arterial and venous disease: Acute stroke

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Abstract
Assessing the patient Patients should be assessed at hospital immediately after a stroke. They may need to go straight to hospital rather than wait to see their general practitioner since hyperacute treatments such as thrombolysis must be administered within as little as three hours after stroke. Ambulance crews can be trained to apply simple screening questions to identify likely stroke patients. View this table: In this window In a new window Characteristics of subtypes of stroke Stroke is a clinical diagnosis, but brain imaging is required to distinguish ischaemia from primary intracerebral haemorrhage. The pattern of neurological signs, including evidence of motor, sensory, or cortical dysfunction and hemianopia, can be used to diagnose certain clinical subtypes and thus to predict prognosis. Other signs also relate to outcome and may help identify the cause. If neurological symptoms resolve in less than 24 hours, the traditional diagnostic label is “transient ischaemic attack” rather than stroke. However, not all transient ischaemic attacks are genuinely ischaemic, and many are associated with permanent cerebral damage: a better term therefore is “mini-stroke.” References Bath PMW . The medical management of stroke. Int J Clin Pract 1997;51:504–10. Lees KR . If I had a stroke…. Lancet 1998;352 (suppl III):28–30. Royal College of Physicians. Stroke audit package. London: RCP, 1994. Stroke Units Trialists' Collaboration. Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke. BMJ 1997;314:1151–9.

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