Improving the Clinical Diagnosis of Stroke

Abstract

See related articles, pages 769–775, 776–780. Clinicians recognize that the history and physical examination form the basis of diagnosis and are critical for determining a treatment plan for patients with suspected stroke. This central role of the history and examination are reflected in the ASA/AHA Stroke Council’s Guidelines for the Early Management of Patients With Ischemic Stroke.1 Quality literature on this important topic is surprisingly limited. After eliminating review articles and case series, a MEDLINE search conducted as part of a systematic review of English language articles (1994–2005) yielded only 4 potentially relevant studies.2 Two related reports now add to our knowledge of this important subject.3,4⇓ Prior work shows that symptoms associated with high interobserver agreement for the diagnosis of stroke or TIA versus no vascular event are a sudden change in speech, visual loss, diplopia, numbness or tingling, paralysis or weakness and nonorthostatic dizziness (κ=0.60, 95% CI: 0.52 to 0.68).2 The reliabilities of individual neurological findings varies from slight to almost perfect but can be improved with the use of standardized scoring systems.2 The first of the 2 new reports focuses on interobserver agreement (ie, reliability) for the bedside clinical assessment of patients with suspected stroke.3 There are 2 important caveats to bear in mind when considering the results. Historic information was obtained only from the patients themselves, many of whom were confused. In the usual clinical setting, historic information is gleaned from …