TIA/stroke history

Question 1

What are the focused questions to ask for suspected TIA/stroke?

Answer 1

Note any dysarthria (slurring of speech) or any dysphasia (problems with comprehension or execution of speech)

Presenting complaint:

• distribution
• severity
• weakness
• do you notice any weakness in your body
• distribution: is it more in your legs or in your arms/face; can you smile for me
• severity: how severe is it? are you still able to walk
• onset:did it come on suddenly? has it gotten worse
• sensory changes
• did you notice any changes in the sensation of the body
• distribution: is it more in your legs or in your arms/face; can you smile for me
• severity: how does it feel like-completely numb or pins and needles
• onset:did it come on suddenly? has it gotten worse
• vision
• can you describe the changes in your vision
• severity-is it blur or is it complete loss of vision
• speech
• dysphagia-solids or liquids (aspiration pneumonia is a risk factor)
• ataxia
• any problems with balance or do you feel like the room is spinning (posterior circulation stroke)
• reduced levels of consciousness
• do you find yourself more drowsy
• any trauma to your head
• any headache, nausea vomiting, vision changes (ICP)
• pain

Check for other DDx:

• septic emboli-fever, night sweats, chest pain; atrial fibrillation-palpitations
• headache, nausea vomiting, papilloedema-malignant middle cerebral artery syndrome (space occupying infarct); rule out migraine

PMH/SH:

• ask for heart problems (AF) or prosthetic valves
• ask fo vascular risk factors-hypertension, hyperlipidaemia, DM
• any previous surgeries

DH:

• oral contraceptive pill/HRT
• allergies

FH:

• any stroke within the family

LH:

• type of the accomodation they live in and any adaptation for them to live
• do they require a carer
• are they able to wash/dress themselves; cook/do groceries
• occupation
• driving (DVLA important)
• smoking/alcohol/drugs history

Question 2

What are the things to look out post stroke?

Answer 2

poor swallow or gagging-> aspirate causing aspiration pneumonia. Need a SALT assessment

NG tube or PEG

visual fields and neglect

pulse for atrial fibrillation

carotid bruits

Additional signs:

pyramidal weakness (flexed arm and circumducting leg due to weakness on the affected side)

walking aids

oedema on the affected side (due to poor movement causing lack of lymph drainage)

VII facial nerve palsy sparing forehead and eyes

UMN signs

• hypertonia: clasp knife spasticity: passively flex arm; resistance is felt at first but after a certain point it gets easier due to reduction in resistance
• clonus and upward going babinski’s sign
• hyperreflexia