When he arrives at the hospital he is seen immediately to assess:
- whether he is likely to have had a stroke, and if so
- whether he might be suitable for thrombolysis and/or thrombectomy?
The doctor arranges an urgent CT brain scan.
Q. Some of these symptoms make a diagnosis of stroke more likely, whilst others make a diagnosis of stroke less likely.
Likely stroke
Sudden onset – Stroke symptoms nearly always come on acutely. In patients with suspected stroke presenting to the emergency room symptoms came on acutely in 96% of those who had a diagnosis of confirmed stroke compared to 47% of patients with non-stroke diagnoses.
Arm and leg weakness – 75.5% of hospitalised stroke patients with a confirmed stroke present with paresis of an arm on admission. Only 12% of patients with suspected stroke presenting to the emergency room who turn out to have a non-stroke diagnosis have signs of arm paresis. 68.6% of hospitalised stroke patients with a confirmed stroke present with paresis of a leg on admission. Only 11% of patients with suspected stroke presenting to the emergency room who turn out to have a non-stroke diagnosis have signs of leg paresis.
Facial weakness – 54.6% of hospitalised stroke patients with a confirmed stroke present with paresis of the face on admission. Only 3% of patients with suspected stroke presenting to the emergency room who turn out to have a non-stroke diagnosis have signs of facial weakness.
Speech disturbance – In patients with suspected stroke presenting to the emergency room 57% of those who had a diagnosis of confirmed stroke had signs of abnormal speech (dysphasia, dysarthria) compared to 47% of patients with non-stroke diagnoses.
May be stroke
Headache – Headache isn’t helpful in distinguishing stroke from “stroke mimic” as it is present in equal numbers in both groups. 15-25% of patients with a stroke have a headache on admission.
Dizziness – “Dizziness” isn’t a helpful term and it’s meaning should be clarified with the patient. In patients with suspected stroke presenting to the emergency room only 13% of those who had a diagnosis of confirmed stroke complained of symptoms of dizziness an admission compared to 33% of patients with non-stroke diagnoses. In the same group of patients those specifically complaining of vertigo were as likely to have a final diagnosis of stroke (6%) stroke as non-stroke (5%).
Double vision
Unlikely stroke
Convulsive seizure – It is very unusual for patients with a confirmed stroke at onset to have a seizure at onset. Of patients with suspected stroke presenting to the emergency room only 1% of those who have a diagnosis of stroke confirmed present with convulsive seizure compared to 10% who have a non-stroke diagnosis confirmed.
Confusion – Of patients with suspected stroke presenting to the emergency room only 5% of those who have a diagnosis of stroke confirmed present with confusion compared to 25% who have a non-stroke diagnosis confirmed.
Loss of consciousness – Loss of consciousness is very unusual in patients presenting with a stroke. Of patients with suspected stroke presenting to the emergency room only 6% of those who have a diagnosis of stroke confirmed present with loss of consciousness compared to 41% who have a non-stroke diagnosis confirmed.
Chest tightness
Flashing lights in vision
Amnesia
Worsening over last week
