What are specific interrogation questions for a patient with a cerebrovascular accident (CVA) or stroke?

From the Guidelines

When assessing a stroke patient, specific interrogation questions should focus on timing, symptoms, and risk factors, with the most critical piece of information being the time of symptom onset, as defined by when the patient was last at their previous baseline or symptom-free state 1. To determine this, ask when symptoms began, what symptoms appeared first and how they progressed, and whether the patient experienced sudden weakness or numbness (especially on one side), speech difficulties, vision changes, severe headache, dizziness, or balance problems. Some key points to consider when asking about the time of symptom onset include:

• For patients unable to provide this information or who awaken with stroke symptoms, the time of onset is defined as when the patient was last awake and symptom-free or known to be “normal” 1
• Establishing onset time may require confirming the patient’s, bystander’s, or EMS personnel’s initial assessment 1
• Creative questioning to establish time anchors potentially allows treatment of patients initially identified as “onset time unknown” 1 Inquire about the patient's medical history including:
• Previous strokes or TIAs
• Hypertension
• Diabetes
• Heart disease
• Atrial fibrillation
• High cholesterol
• Smoking status Medication history is essential, particularly use of:
• Anticoagulants like warfarin, apixaban, rivaroxaban, or dabigatran
• Antiplatelet medications like aspirin or clopidogrel Ask about:
• Recent trauma, surgeries, or unusual activities
• Oral contraceptive use or hormone replacement therapy for female patients These questions help determine stroke type (ischemic vs. hemorrhagic), eligibility for time-sensitive treatments like tPA (which must typically be administered within 4.5 hours of symptom onset), and guide secondary prevention strategies 1. The information gathered also helps establish baseline function for rehabilitation planning. It is also important to note that the severity of stroke, based on the findings detected by neurological examination, is a strong indicator of prognosis, and several reliable and well-validated scoring systems, such as the National Institutes of Health Stroke Scale (NIHSS), have been developed to assess this 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Interrogation Questions for Stroke Patients

When interrogating a stroke patient, healthcare professionals may ask specific questions to assess their condition and determine the best course of treatment. Some of these questions may include:

• What were your symptoms when you first experienced the stroke?
• Have you experienced any previous strokes or transient ischemic attacks (TIAs)?
• Do you have a history of atrial fibrillation or other heart conditions?
• Are you currently taking any medications, such as anticoagulants or antiplatelets?
• Have you noticed any changes in your vision, speech, or mobility since the stroke?

Assessment of Stroke Risk Factors

Healthcare professionals may also ask questions to assess the patient's risk factors for stroke, such as:

• Do you have a family history of stroke or cardiovascular disease?
• Do you have high blood pressure, diabetes, or high cholesterol?
• Are you a smoker or do you use tobacco products?
• Do you engage in regular physical activity or exercise?
• Do you follow a healthy diet and maintain a healthy weight?

Medication Management

Questions about medication management may include:

• What medications are you currently taking, and what are the dosages?
• Have you experienced any side effects or interactions with your medications?
• Are you taking any anticoagulants or antiplatelets, such as aspirin, warfarin, or clopidogrel?
• Have you been prescribed any new medications since the stroke, such as alteplase?
• Are you experiencing any difficulties with medication adherence or management? 2, 3, 4

Treatment Outcomes and Prognosis

Healthcare professionals may also ask questions to assess the patient's treatment outcomes and prognosis, such as:

• How have your symptoms changed since the stroke?
• Have you experienced any improvements or declines in your functional abilities?
• Are you experiencing any complications or side effects from treatment, such as hemorrhagic transformation?
• What are your goals and expectations for recovery and rehabilitation?
• Are there any concerns or questions you have about your treatment or prognosis? 5, 6