From the Guidelines
To assess for stroke, a rapid initial evaluation for airway, breathing, and circulation should be conducted, followed by a neurological examination to determine focal neurological deficits and assess stroke severity using a standardized stroke scale such as the National Institutes of Health Stroke Scale (NIHSS) 1. The diagnostic criteria for assessing a cerebral vascular accident (CVA) or stroke include:
- A rapid initial evaluation for airway, breathing, and circulation
- A neurological examination to determine focal neurological deficits and assess stroke severity
- Assessment of heart rate and rhythm, blood pressure, temperature, oxygen saturation, hydration status, and presence of seizure activity
- Acute blood work, including electrolytes, random glucose, complete blood count, coagulation status, and creatinine
- Brain imaging with non-contrast CT (NCCT) or MRI to confirm the diagnosis of symptomatic ischemic cerebral vascular disease 1
- A validated triage tool, such as ASPECTS, to rapidly identify patients who may be eligible for endovascular treatment (EVT) 1 The following signs and symptoms should also be checked:
- Sudden severe headache
- Dizziness
- Loss of balance
- Vision problems
- Confusion
- Facial drooping
- Arm weakness
- Slurred or strange speech It is essential to note that stroke is a medical emergency requiring immediate attention, and every minute delay can result in the loss of approximately 1.9 million neurons. Quick recognition and emergency transport to a hospital capable of stroke treatment is crucial, as certain treatments like tissue plasminogen activator (tPA) must be administered within a specific time window, typically within 3-4.5 hours of symptom onset for maximum effectiveness. Some key recommendations for diagnostic evaluation include:
- ECG to screen for atrial fibrillation and atrial flutter and to assess for other concomitant cardiac conditions 1
- Noninvasive cervical carotid imaging with carotid ultrasonography, CT angiography (CTA), or magnetic resonance angiography (MRA) to screen for stenosis in patients with symptomatic anterior circulation cerebral infarction or TIA who are candidates for revascularization 1
- Blood tests, including complete blood count, prothrombin time, partial thromboplastin time, glucose, HbA1c, creatinine, and fasting or nonfasting lipid profile, to gain insight into risk factors for stroke and to inform therapeutic goals 1
From the Research
Diagnostic Criteria for Cerebral Vascular Accident (CVA) or Stroke
The diagnostic criteria for assessing a cerebral vascular accident (CVA) or stroke involve various clinical tests and scales. Some of the key diagnostic criteria include:
- The Face Arm Speech Test (FAST) 2, 3, 4
- The Cincinnati Pre-hospital Stroke Scale (CPSS) 2
- The National Institute of Health Stroke Scale (NIHSS) 5
- The modified Rankin Scale 5
- The Balance-Eyes-Face-Arms-Speech-Time (BEFAST) scale 3, 4
Clinical Tests and Scales
These clinical tests and scales are used to assess patients with suspected stroke and determine the severity of their symptoms. For example:
- The FAST test assesses facial weakness, arm weakness, and speech disturbances 2, 3, 4
- The BEFAST scale adds assessments of balance and diplopia to the FAST test 3, 4
- The NIHSS score is used to assess the severity of neurological symptoms in patients with acute ischemic stroke 5
Limitations of Diagnostic Criteria
While these diagnostic criteria are widely used, they may have limitations in certain cases. For example: