Health of Older People  |  TIA Pathway - Persistent Symptoms At Time Of Assessment




Health of Older People

TIA Pathway - Persistent Symptoms At Time Of Assessment

If the patient still has symptoms or signs of stroke at the time of assessment they need to be admitted to hospital immediately. Stroke is a medical emergency.

** This pathway recognises that some patients present late. If a patient has probably had a stroke and presents after 2 weeks or more, they can be referred to the TIA Clinic instead (in the absence of any other reason for admission).

FAST Screening Test:

  • FACE - ask the patient to smile. Is there a facial droop on one side?
  • ARM - ask the patient to raise both arms to 90 degrees. Is there a weakness on one side?
  • SPEECH - is there a new speech disturbance eg slurring, word-finding difficulties or difficulty naming objects?
  • TIME - if the patient has any of these signs at the time of assessment, get to hospital FAST. They may be eligible for thrombolysis. Early intervention in stroke makes a difference.

The FAST screening test looks for signs of stroke in the carotid (anterior) circulation. Remember that posterior circulation strokes also need to be admitted to hospital.

The table below outlines the clinical features of TIA/stroke with arterial territory:

Anterior (carotid) circulation

Posterior (vertebrobasilar) circulation

  • Cortical dysfunction (ie dysphasia, sensory or visual inattention, hemianopia)
  • Monocular blindness
  • Unilateral weakness
  • Unilateral sensory disturbance
  • Dysarthria*
  • Neuromuscular dysphagia*
  • Cranial nerve palsy
  • Ataxia/inco-ordination
  • Diplopia
  • Isolated homonymous hemianopia
  • Bilateral visual loss
  • Unilateral/bilateral weakness
  • Unilateral/bilateral sensory disturbance
  • Dysarthria*
  • Neuromuscular dysphagia*

*Less likely to be TIA/stroke if symptoms in isolation.



Last updated : Friday, November 24, 2017
Next review date : Saturday, November 24,2018


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