Clinical Review ABC of arterial and venous disease

Acute stroke

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7239.920 (Published 01 April 2000) Cite this as: BMJ 2000;320:920
  1. Philip M W Bath,
  2. Kennedy R Lees

    Acute stroke is now a treatable condition that deserves urgent specialist attention. Drug treatment and specialist care both influence survival and recovery. This article considers the optimal approaches to diagnosis and early management.

    Conditions requiring referral to hospital

    Admit to hospital
    • Neurological deficit lasting 1 hour or more

    • Dependent patients—that is, moderate to severe stroke

    • Transient ischaemic attack lasting 1 hour or more

    • More than one transient ischaemic attack within a week

    • Transient ischaemic attack on anticoagulation

    • Patient presenting to hospital

    • At request of general practitioner

    Refer to cerebrovascular clinic
    • Independent patient more than 48 hours after stroke (withhold aspirin)

    • Transient ischaemic attack lasting less than 1 hour (give aspirin)

    Symptoms and signs of stroke

    Anterior circulation strokes
    • Unilateral weakness

    • Unilateral sensory loss or inattention

    • Isolated dysarthria

    • Dysphasia

    • Vision:

      Homonymous hemianopia

      Monocular blindness

      Visual inattention

    Posterior circulation strokes
    • Isolated homonymous hemianopia

    • Diplopia and disconjugate eyes

    • Nausea and vomiting

    • Incoordination and unsteadiness

    • Unilateral or bilateral weakness and/or sensory loss

    Non-specific signs
    • Dysphagia

    • Incontinence

    • Loss of consciousness

    Stroke, a sudden neurological deficit of presumed vascular origin, is a clinical syndrome rather than a single disease. It is a common and devastating condition that causes death in one third of patients at six months and leaves another third permanently dependent on the help of others. Each year in the United Kingdom there are 110 000 first strokes and 30 000 recurrent strokes; 10 000 strokes occur in people younger than 65 and 60 000 people die of stroke. It is the largest cause of disability, and more than five per cent of NHS and social services resources are consumed by stroke patients. Correct management relies on rapid diagnosis and treatment, thorough investigation, and rehabilitation.

    Assessing the patient

    Patients should be assessed at hospital immediately after a stroke. They may need to go straight to hospital rather than wait to see their general practitioner since hyperacute treatments such as thrombolysis must be administered within as little as three hours after stroke. Ambulance …

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