Presentation

Stroke symptoms typically start suddenly, over seconds to minutes, and in most cases do not progress further. The symptoms that do occur depend on the location of the Cerebrovascular accident within the brain. For example, the more extensive the areas of brain affected, the more functions that are likely to be lost.

The presence of a stroke is generally indicated by the development of sudden-onset facial weakness, arm drift or drop, abnormal speech, eyesight changes and confusion. The UK system for diagnosis includes the FAST screen (face, arm, speech and time) and was advocated by the Department of Health. Fig.9 illustrates the facial changes as seen in a stroke patient- note the hemiplegia.

Fig.9- Altered photograph illustrating facial weakness in a cerebrovascular accident.

Both Ischaemic and Haemorrhagic strokes are difficult to distinguish clinically without Investigations such as CT. But, an experienced clinician may look for…

Evidence of thrombosis: progressive deterioration, atherosclerosis risk factors, a carotid bruit.

Evidence of embolism: Abrupt onset, history of atrial fibrillation, Recent Myocardial infarction, Prior TIA/ Stroke.

Evidence of haemorrhage: abrupt onset, headaches, fits, hypertension risk factors, rapid decrease in level of consciousness.

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