Initial assessment and management of stroke

Abstract

This second article, in a two-part series on stroke, will review and outline the importance of the initial assessment and management of patients with stroke in hospital. Stroke affects over 111 000 individuals per year, with almost 1 million individuals managing daily with its after-effects in England. The management of patients with stroke has rapidly developed in recent years, with widespread access to intravenous thrombolytic therapy for the preponderance (85%) of acute ischaemic stroke, while the remaining haemorrhagic strokes (15%) can potentially be managed with a decompressive hemicraniectomy procedure. Further developments include mechanical thrombectomy that treats large-vessel occlusive stroke using an interventional neuroradiology procedure called mechanical thrombectomy. Ensuring delivery of appropriate stroke treatments relies on the accurate assessment of the patient, with particular attention to their past medical history, cardiovascular risk factors and access to hyperacute stroke care. The key risks factors for stroke will also be discussed, as many of these may only present at stroke diagnosis. A range of stroke assessment tools, including their effectiveness, will be discussed in addition to differential stroke diagnosis and stroke mimics.