From the Guidelines
When interviewing a patient who has recently experienced a stroke, focus on questions that assess the timeline, symptoms, risk factors, and current functional status, as recommended by the most recent guidelines 1. Begin by asking about the onset of symptoms: "When did you first notice something was wrong?" and "What symptoms did you experience?" Determine if the patient had warning signs like transient ischemic attacks (TIAs) before the stroke. Ask about specific symptoms such as weakness, numbness, speech difficulties, vision changes, headache, dizziness, or loss of balance. Inquire about cardiovascular risk factors including hypertension, diabetes, high cholesterol, smoking, alcohol consumption, and family history of stroke. Review the patient's medication history, particularly anticoagulants, antiplatelets, or antihypertensives, as suggested by 1. Ask about previous strokes or heart conditions like atrial fibrillation. Assess current functional status with questions about mobility, speech, swallowing difficulties, vision problems, and ability to perform daily activities. Evaluate cognitive function by asking about memory issues, confusion, or personality changes. Some key questions to ask include:
- Time patient last known well
- Time symptoms were first observed
- History of diabetes
- History of hypertension
- History of seizures
- History of trauma related to current event
- History of myocardial infarction or angina
- History of cardiac arrhythmias
- Atrial fibrillation
- History of prior stroke or TIA
- What medications is patient currently taking
- Is patient receiving anticoagulation therapy with warfarin, as outlined in 1. Finally, inquire about the patient's support system and home environment to determine if additional resources are needed for recovery, as recommended by 1. These questions help establish the stroke type, potential causes, and guide appropriate treatment and rehabilitation planning. It is also important to note that the time of symptom onset is crucial in determining the eligibility for therapeutic interventions in acute ischemic stroke, as highlighted in 1. Therefore, establishing the onset time is critical, and creative questioning may be necessary to determine this information 1.
From the Research
Interrogation Questions for Stroke Patients
When interrogating a patient who has had a recent stroke, the following questions can be asked to gather relevant information:
- What were your symptoms when the stroke occurred?
- How long did it take to seek medical attention after the onset of symptoms?
- Have you been taking any medications, such as anticoagulants or antiplatelets, prior to the stroke? 2
- Do you have a history of atrial fibrillation? 3, 4
- Have you experienced any bleeding events in the past?
- What is your current level of consciousness and cognitive function?
Medical History
It is also important to ask about the patient's medical history, including:
- Previous strokes or transient ischemic attacks (TIAs)
- History of hypertension, diabetes, or hyperlipidemia
- Use of aspirin, warfarin, or new anticoagulants for stroke prevention 4
- Any allergies or sensitivities to medications
Treatment and Outcomes
Questions about treatment and outcomes can include:
- What treatment was administered after the stroke, such as thrombolytic therapy with alteplase? 3, 2, 5
- What were the results of any imaging studies, such as CT or MRI scans?
- What is the patient's current level of functional impairment and disability?
- Are there any plans for rehabilitation or follow-up care?