From the Guidelines
A comprehensive physical examination for a patient with minor stroke should prioritize a detailed neurological assessment, cardiovascular evaluation, and identification of stroke risk factors, as outlined in the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack 1. The examination should begin with vital signs, including blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation.
- A detailed neurological examination using the National Institutes of Health Stroke Scale (NIHSS) should be performed to assess level of consciousness, language function, visual fields, facial symmetry, motor strength in all extremities, sensory function, coordination, and gait.
- Cranial nerves I-XII should be evaluated systematically.
- Cardiovascular status should be assessed by auscultating for carotid bruits, cardiac murmurs, and irregular rhythms that might suggest atrial fibrillation, as recommended in the 2021 guideline 1.
- Peripheral pulses should be checked and signs of peripheral vascular disease looked for.
- The examination should also include looking for signs of other stroke risk factors such as xanthelasma (suggesting hyperlipidemia) or acanthosis nigricans (suggesting insulin resistance). This thorough examination helps determine stroke severity, identify the likely vascular territory affected, establish a baseline for monitoring recovery, and detect modifiable risk factors that require management, as emphasized in the guidelines for the early management of patients with acute ischemic stroke 1. The findings will guide immediate treatment decisions, including thrombolysis eligibility, antiplatelet therapy initiation, blood pressure management, and secondary prevention strategies, with the goal of reducing morbidity, mortality, and improving quality of life.
From the Research
Physical Examination of a Patient with Minor Stroke
The physical examination of a patient with minor stroke is crucial in assessing the severity of the stroke and guiding treatment decisions.
- The patient's medical history, including any previous strokes or transient ischemic attacks (TIAs), should be reviewed 2, 3, 4, 5, 6.
- A thorough physical examination should be performed to assess the patient's neurological function, including their level of consciousness, speech, vision, strength, and coordination 2, 3, 4, 5, 6.
- The patient's vital signs, including blood pressure, heart rate, and oxygen saturation, should be monitored closely 2, 3, 4, 5, 6.
Treatment Options
The treatment options for a patient with minor stroke include antiplatelet therapy, such as aspirin or clopidogrel, to reduce the risk of recurrent stroke 2, 3, 4, 5, 6.
- Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel may be considered for patients with minor stroke or TIA, especially if started within 24 hours of the onset of symptoms 2, 3, 4, 5, 6.
- However, DAPT is associated with an increased risk of bleeding, and the benefits and risks should be carefully weighed for each patient 2, 3, 4, 5, 6.
Risk of Bleeding
The risk of bleeding is a significant concern when using DAPT in patients with minor stroke or TIA 2, 3, 4, 5, 6.