Stroke (CVA/TIA)

Table of contents

Mimics


Face	Facial droop or asymmetry
Arm	- Arm drift - Weakness - Other neurological deficit
Speech	Is the patients speech slurred or abnormal?
Time	T < 9/24 since Sx onset (or <9/24 since waking with new Sx onset - covers wake up strokes)

Some hospitals (mainly the SJOG ones) are now adding BE to FAST for BEFAST

If patient is FAST +ve, evaluate using RACE. RACE >= 5 divert to neuroendovascular centre.

	0	1	2
Facial palsy	Absent	Mild	Moderate to severe
Arm motor function	Normal to mild	Moderate	Severe
Leg motor function	Normal to mild	Moderate	Severe
Head/gaze deviation	Absent	Present
Aphasia (if right hemiparesis)	Performs both tasks correctly	Performs 1 task correctly	Performs neither task correctly
Agnosia (if left hemiparesis)	Patient recognises his/her arm and the impairment	Does not recognise his/her arm or the impairment	Does not recognise his/her arm nor the impairment

Considered a good test to consider posterior strokes. Must have Ataxia and/or Visual Disturbance


Ataxia	Acute, sudden onset
Visual Disturbance	Acute, sudden onset
Vertigo
Vomiting	Vomiting stronger predictive value than nausea

Dysdiadochokinesis: the hand flippy quickly test
Ataxia: A sudden onset of ataxia
Nystagmus: Can be horizontal or vertical
Intention tremor: Finger tip to nose test, also helps with visual field
Scanning dysarthria: Words like “University” and “Hippopotamus”, the emphasis is on the wrong sylable (Scanning) and dysarthira is slowness/slurring of words
Heel-shin test positivity: Similar to the finger to nose test for intention tremor
Dysmetria: Under/over shoots target during finger to nose test
Arm-grip: Pull arm while protecting patient and let go, if it rebounds without the patint trying to / able to arrest the return of the arm fail test

Check patient tone as well (Hypotonia)