Neurology  |  Stroke Pathway - FAST+ve Presentation at GP, Rest Home or Community




Neurology

Stroke Pathway - FAST+ve Presentation at GP, Rest Home or Community

1. Typical features include

  • Numbness.
  • Weakness and paralysis – may be confined to face, arm or leg only.
  • Problems with speech and comprehension or slurred speech.
  • Visual disturbances.
  • Disorders or perception Disorder of balance, co-ordination.
  • Acute problems with swallowing.
  • Acute presentations restricted to isolated dizziness/vertigo or isolated delirium (not aphasia) or isolated loss of consciousness should not be managed as stroke, but may still need urgent attention.


FAST (F-A-S-T):

Use the Face, Arm, Speech, Time Test to screen for diagnosis of stroke, but note some patients with stroke will be FAST negative. Examples include hemianopis, quadrantanopias or diplopia or ataxic limbs. (Posterior Circulation Stroke).

Fnew onset facial weakness:

  • Ask patient to smile or show their teeth.
  • The FAST test is +ve if there is new facial asymmetry.

Anew onset arm weakness:

  • Raise the patients arms to 90 degrees if they are sitting or 45 degrees if they are lying.
  • Ask the patient to maintain the position when you let go.
  • The FAST test is +ve if, when you let go, one arm falls or drifts.
     

Sspeech problems:

  • Assess the patient’s speech and determine if it is slurred or the person has difficulty finding the name for commonplace objects.
  • If they have difficulty seeing, place the object in their hands.
  • If they have a companion, check whether this is a new problem.
  • The FAST test is +ve if there is a new unexplained speech problem.

T‘time in brain’. Urgent treatment in the hospital to reverse symptoms may be possible – do not delay.


The ROSIER (Risk of Stroke in the Emergency Room) assessment scale. This scale is used in ED as an assessment tool, when symptoms are less clear. This form can be used in General Practice to assist diagnosis. The Rosier has a 93% sensitivity, a 83% specificity, 90% positive predictive value, and a 88% negative predictive value. Ref Lancet Neurol. 2005 Nov: 4 (11) 691-3.

 The FAST screening test looks for signs of stroke in the carotid (anterior) circulation. Around 80-85% of strokes will be FAST +ve. 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, August 21, 2015
Next review date : Saturday, August 20,2016


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