Stroke, TIA & Neurological Deficits
Identify sudden focal deficits, protect time-sensitive treatment opportunities and prevent early complications.
Quick revision ↓ Medical Dictionary
01Recognise and time the event
Sudden weakness, speech change, visual loss or imbalance can indicate stroke. Record the exact onset or last-known-well time and seek an urgent stroke pathway. FAST is useful but does not capture every posterior-circulation presentation. Check glucose early because hypoglycaemia can mimic a focal deficit. Do not allow spontaneous improvement or a young age to remove concern when the neurological history is convincing.
02Localise and assess severity
Examine consciousness, speech, cranial nerves, visual fields, motor function, sensation and coordination as appropriate without delaying urgent imaging. Document anticoagulant use, recent procedures, baseline function and relevant contraindications. A structured scale can support communication, but isolated disabling symptoms still matter. Seizure, migraine, functional symptoms and metabolic disease are possible mimics; consideration of mimics must not become a reason for avoidable delay.
03Image before specific treatment
Urgent brain imaging distinguishes haemorrhage from ischaemia and supports eligibility assessment for reperfusion. Additional vessel or perfusion imaging is selected through the specialist pathway. Thrombolysis and thrombectomy are not interchangeable or suitable for every patient; timing, anatomy, imaging and contraindications determine options. Antithrombotic treatment in ongoing suspected stroke requires appropriate exclusion of haemorrhage and a clinician-led plan.
04Protect the patient after arrival
Assess swallowing before food, drink or oral medication. Monitor oxygenation, temperature, glucose, pressure and neurological change, using the stroke team's targets rather than aggressive unplanned correction. Positioning, venous-thrombosis prevention, mobilisation, nutrition and rehabilitation are individualised. New headache, vomiting or deterioration can signal a complication and requires urgent reassessment, not simply attribution to the original deficit.
05TIA and prevention
A transient focal episode still requires urgent assessment because early stroke risk can be important. Use the local TIA pathway, including prompt appropriate antiplatelet decisions and specialist review; do not delay referral solely because a score appears low. Prevention addresses atrial fibrillation, carotid disease, pressure, lipids and smoking as indicated. Explain recurrence symptoms and ensure the patient knows to seek emergency care if they return.
High-Yield Revision
- Record last-known-well time and bedside glucose.
- A negative FAST screen does not exclude every stroke.
- Assess swallowing before oral intake.
Common Pitfalls
- Do not give stroke-specific antithrombotics without the appropriate haemorrhage assessment.
- Do not dismiss resolved focal symptoms as harmless.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.