Stroke

Stroke is a common presentation to all Emergency Helath care providors, with around 150,000 strokes occurring in the UK each year! Our impact and treatment can be hugely significant and in this podcast we’re going to conver the topic in some depth, and importantly cover some of the new Guidance published by NICE in their ‘Stroke and transient ischaemic attack in the over 16’s diagnosis and initial management’ document that was published in May of this year.

We’ll be running through

  • Definition
  • Pathophysiology
  • Territories
  • Risk factors
  • Assessment; both prehospitally and in hospital
  • Stroke mimics
  • Investigations

As always we’d love to hear any thoughts or comments you have on the website and via twitter.

Enjoy!

SimonRob & James

References

Stroke & Dizziness; PHEMCAST

RCEMLearning; RCEM Belfast Vertigo

Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline.Published: 1 May 2019

Acute Stroke Lecture notes; LITFL

Stroke Thrombolysis; LITFL

Are you at risk of a Stroke; Stroke Association

Modifiable Risk Factors for Stroke and Strategies for Stroke Prevention.Hill VA. Semin Neurol. 2017

A systematic review of stroke recognition instruments in hospital and prehospital settings. Rudd M. Emerg Med J. 2016

Acute Stroke Diagnosis. Kenneth S. Yew. Am Fam Physician. 2009

Imaging of acute stroke prior to treatment: current practice and evolving techniques.G Mair. Br J Radiol. 2014

Should CT Angiography be a Routine Component of Acute Stroke Imaging?Vanja Douglas. Neuro hospitalist. 2015

Comparative Sensitivity of Computed Tomography vs. Magnetic Resonance Imaging for Detecting Acute Posterior Fossa Infarct. David Y Hwang. J Emerg Med. 2013

Posterior circulation ischaemic stroke. A Merwick BMJ 2014

Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack (Review) Zhelev Z, Walker G, Henschke N, Fridhandler J, Yip S. 2019. Cochrane.

1 Comment

  • Just on the point about Hints exam not being in the nice guidance, it does show up in the nice guidance on suspected neurological conditions under vertigo.

    “For adults with sudden-onset acute vestibular syndrome (vertigo, nausea or
    vomiting and gait unsteadiness), a HINTS (head-impulse–nystagmus–test-of-
    skew) test should be performed if a healthcare professional with training and
    experience in the use of this test is available.”

    I suspect future arguments will come from if EM physicians count as trained and experienced in the use of Hints.

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