1. Typical features include
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).
F – new onset facial weakness:
A – new onset arm weakness:
S – speech problems:
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|
*Less likely to be TIA/stroke if symptoms in isolation.
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