Guidance
Key priorities for implementation
Key priorities for implementation
Rapid recognition of symptoms and diagnosis
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In people with sudden onset of neurological symptoms a validated tool, such as FAST (Face Arm Speech Test), should be used outside hospital to screen for a diagnosis of stroke or TIA.
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People who have had a suspected TIA who are at high risk of stroke (that is, with an ABCD2 score of 4 or above) should have:
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aspirin (300 mg daily) started immediately
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specialist assessment[6] and investigation within 24 hours of onset of symptoms
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measures for secondary prevention introduced as soon as the diagnosis is confirmed, including discussion of individual risk factors.
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People with crescendo TIA (two or more TIAs in a week) should be treated as being at high risk of stroke, even though they may have an ABCD2 score of 3 or below.
Specialist care for people with acute stroke
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All people with suspected stroke should be admitted directly to a specialist acute stroke unit[7] following initial assessment, either from the community or from the A&E department.
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Brain imaging should be performed immediately[8] for people with acute stroke if any of the following apply:
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indications for thrombolysis or early anticoagulation treatment
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on anticoagulant treatment
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a known bleeding tendency
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a depressed level of consciousness (Glasgow Coma Score below 13)
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unexplained progressive or fluctuating symptoms
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papilloedema, neck stiffness or fever
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severe headache at onset of stroke symptoms.
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Nutrition and hydration
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On admission, people with acute stroke should have their swallowing screened by an appropriately trained healthcare professional before being given any oral food, fluid or medication.
[6] Specialist assessment includes exclusion of stroke mimics, identification of vascular treatment, identification of likely causes, and appropriate investigation and treatment.
[7] An acute stroke unit is a discrete area in the hospital that is staffed by a specialist stroke multidisciplinary team. It has access to equipment for monitoring and rehabilitating patients. Regular multidisciplinary team meetings occur for goal setting.
[8] The GDG felt that 'immediately' is defined as 'ideally the next slot and definitely within 1 hour, whichever is sooner', in line with the National Stroke Strategy.