Last reviewed: 29 Oct 2020
Last updated: 13 Jul 2020

Summary

Definition

History and exam

Key diagnostic factors

  • sudden onset and brief duration of symptoms (minutes)
  • patient/witness report of focal neurological deficit

Other diagnostic factors

  • unilateral weakness or paralysis
  • dysphasia
  • ataxia, vertigo, or loss of balance
  • sudden transient loss of vision in one eye (amaurosis fugax)
  • homonymous hemianopia
  • diplopia
  • risk factors 

Risk factors

  • atrial fibrillation
  • valvular disease
  • carotid stenosis
  • congestive heart failure
  • hypertension
  • hyperlipidaemia
  • diabetes mellitus
  • cigarette smoking
  • alcohol-use disorder
  • advanced age
  • patent foramen ovale (PFO)
  • inactivity
  • obesity
  • hypercoagulability

Diagnostic investigations

1st investigations to order

  • blood glucose
  • full blood count and platelet count
  • prothrombin time, INR, partial thromboplastin time
  • fasting lipid profile
  • serum electrolytes
  • ECG
Full details

Treatment algorithm

Contributors

Expert advisersVIEW ALL

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust 

Manchester

UK 

Biography

MJ is an honorary senior lecturer at the University of Manchester.

Disclosures

MJ declares that he has no competing interests.

Neurology Registrar

Manchester Centre for Clinical Neurosciences

Manchester

UK

Disclosures

RP has been sponsored by Novartis to attend the International Headache Conference.

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:

Jennifer Simpson, MD

Associate Assistant Professor

Department of Neurology

University of Colorado School of Medicine

Denver

CO

Disclosures: JS is a site investigator for the POINT trial.

Ethan Cumbler, MD

Associate Professor

Section of Hospital Medicine

Department of Internal Medicine

Division of Medicine

University of Colorado School of Medicine

Denver

CO

Disclosures: EC declares that he has no competing interests.

Peer reviewersVIEW ALL

Consultant in Stroke Medicine

Addenbrooke’s Hospital

Associate Lecturer

School of Clinical Medicine

University of Cambridge

Cambridge

UK

Disclosures

KK has received travel grants for conferences/speaker honoraria from Bayer, Boehringer, Daiichi-Sankyo, Pfizer, and Shire.

Section Editor, BMJ Best Practice

Disclosures

HDC declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

Disclosures

SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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