I read with great interest the excellent article by Professor Graeme J Hankey and David Blacker (1) on the practical approach to the diagnosis and management of stroke. One of the important problems, is the weakness of the FAST Tool to detect posterior fossa strokes in some patients that might not alert triaging to these patients to stroke physicians and neurologists in the hyperacute centres.
Over the past three years I have not been involved in the management of hyperacute strokes, but sporadically I have met patients who have been effectively screened by the paramedics with the FAST tool that has not unravelled symptoms arising from the posterior fossa. Both FAST and ABCD2 scores were less effective in the diagnosis, and identification, of high risk cases for posterior circulation stroke and TIA (2). The same team have suggested including additional parameters in these screening tools, particularly the presence or absence of visual disturbance, can improve the sensitivity with the challenge that it might not keep a good specificity. In a small retrospective assessment, we also showed that inclusion of ataxia and/ or visual disturbances would have improved the earlier detection and triaging posterior fossa strokes for which we proposed FAST –AV or AB (3). The time is due for Stroke Association to sponsor a study to improve on the FAST Tool to cover strokes and TIAs of the posterior Fossa particularly major basilar artery stroke.
References
1. GJ Hankey, DJ Blacker. Is it a stroke? BMJ 2015;350:h56
2. G.Gulli and HS Markus. The use of FAST and ABCD2 scores in posterior circulation, compared with anterior circulation, stroke and transient ischemic attack J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp.2010.222091
3. F. Huwez, E. Casswell. FAST-AV or FAST-AB tool improves the sensitivity of FAST screening for detection of posterior circulation strokes. International Journal of Stroke 2013; 8: E3, letter.
Competing interests:
No competing interests
29 January 2015
Farhad Umer Huwez
Consultant Physician and Geriatrician
Southend University Hospital NHS Trust
Department of Medicine for Elderly, Southend Hospital, Prittlewell Chase, Westcliff-On-Sea, Essex SS0 0RY
Rapid Response:
I read with great interest the excellent article by Professor Graeme J Hankey and David Blacker (1) on the practical approach to the diagnosis and management of stroke. One of the important problems, is the weakness of the FAST Tool to detect posterior fossa strokes in some patients that might not alert triaging to these patients to stroke physicians and neurologists in the hyperacute centres.
Over the past three years I have not been involved in the management of hyperacute strokes, but sporadically I have met patients who have been effectively screened by the paramedics with the FAST tool that has not unravelled symptoms arising from the posterior fossa. Both FAST and ABCD2 scores were less effective in the diagnosis, and identification, of high risk cases for posterior circulation stroke and TIA (2). The same team have suggested including additional parameters in these screening tools, particularly the presence or absence of visual disturbance, can improve the sensitivity with the challenge that it might not keep a good specificity. In a small retrospective assessment, we also showed that inclusion of ataxia and/ or visual disturbances would have improved the earlier detection and triaging posterior fossa strokes for which we proposed FAST –AV or AB (3). The time is due for Stroke Association to sponsor a study to improve on the FAST Tool to cover strokes and TIAs of the posterior Fossa particularly major basilar artery stroke.
References
1. GJ Hankey, DJ Blacker. Is it a stroke? BMJ 2015;350:h56
2. G.Gulli and HS Markus. The use of FAST and ABCD2 scores in posterior circulation, compared with anterior circulation, stroke and transient ischemic attack J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp.2010.222091
3. F. Huwez, E. Casswell. FAST-AV or FAST-AB tool improves the sensitivity of FAST screening for detection of posterior circulation strokes. International Journal of Stroke 2013; 8: E3, letter.
Competing interests: No competing interests