Patient Education Public education must involve all age groups. Incorporating stroke into basic life support (BLS) and cardiopulmonary resuscitation (CPR) curricula is just one way to reach a younger audience. Avenues to reach an audience with a higher stroke risk could include employers, and senior organizations to promote stroke awareness. The American Stroke Association (ASA) advises the public to be aware of the symptoms of stroke that are easily recognized, including the sudden onset of any of the following, and to call 911 immediately: Numbness or weakness of face, arm, or leg, especially on 1 side of the body Confusion Difficulty in speaking or understanding Deterioration of vision in 1 or both eyes Difficulty in walking, dizziness, and loss of balance or coordination Severe headache with no known cause In the spring of 2013, the ASA launched a stroke public education campaign that uses the acronym FAST to teach the warning signs of stroke and the importance of calling 911, as follows: F: Face drooping A: Arm weakness S: Speech difficulty

Diagnostic Considerations Stroke mimics commonly confound the clinical diagnosis of stroke. One study reported that 19% of patients diagnosed with acute ischemic stroke by neurologists before cranial CT scanning actually had non-cerebrovascular causes for their symptoms. The most frequent stroke mimics include the following: Seizure (17%) Systemic infection (17%) Brain tumor (15%) Toxic-metabolic disorders, such as hyponatremia and hypoglycemia (13%) Positional vertigo (6%) Conversion disorder

Ischemic versus hemorrhagic stroke Although the definitive distinction of ischemic stroke from hemorrhagic stroke requires neuroimaging, a meta-analysis found that the following clinical findings increase the probability of hemorrhagic stroke Coma Neck stiffness Seizures accompanying the neurologic deficit Diastolic blood pressure >110 mm Hg Vomiting Headache Findings that decrease the probability of hemorrhage include cervical bruit and prior transient ischemic attack

Additional laboratory tests are tailored to the individual patient and may include the following: Cardiac biomarkers cbc Toxicology screen Fasting lipid profile Erythrocyte sedimentation rate Pregnancy test Antinuclear antibody (ANA) Rheumatoid factor Homocysteine level

Other Imaging Studies in Ischemic Stroke Transcranial Doppler ultrasonography is useful for evaluating more proximal vascular anatomy—including the middle cerebral artery (MCA), intracranial carotid artery, and vertebrobasilar artery—through the infratemporal fossa. Echocardiography is obtained in all patients with acute ischemic stroke in whom cardiogenic embolism is suspected. Chest radiography has potential utility for patients with acute stroke. However, obtaining a chest radiograph should not delay the administration of rt-PA, The use of single-photon emission CT (SPECT) scanning in stroke is still experimental and is available only at select institutions. Theoretically, it can define areas of altered regional blood flow. Conventional angiography is the gold standard in evaluating for cerebrovascular disease as well as for disease involving the aortic arch and great vessels in the neck. Conventional angiography can be performed to clarify equivocal findings or to confirm and treat disease seen on MRA, CTA, transcranial Doppler, or ultrasonography of the neck.