What are the key components of the acute assessment for a patient presenting with symptoms of stroke or TIA?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Key components of the acute assessment for a patient presenting with symptoms of stroke or transient ischemic attack (TIA) include:

  • Immediate recognition and rapid emergency admission to an acute stroke facility for anyone with suspected acute stroke or emergent TIA from age 16 years onwards. This includes patients with ongoing focal neurological deficits even if the FAST test is negative, who must be managed as acute stroke cases.
  • Use of validated screening tools such as FAST (Face Arm Speech Test) outside hospital and ROSIER (Recognition of Stroke in the Emergency Room) in the emergency department to rapidly identify stroke or TIA.
  • Exclude hypoglycaemia as a cause of sudden neurological symptoms.
  • Ensure advanced notification to the receiving hospital including time of symptom onset, symptom evolution, current condition, and medications, especially anticoagulants.
  • While awaiting transfer, monitor and manage airway, breathing, and circulation (ABCs), and provide supplemental oxygen if oxygen saturations are below 95% without contraindications.
  • Urgent brain imaging (preferably CT) must be performed urgently and within 1 hour of hospital arrival to exclude intracerebral haemorrhage before starting anticoagulation or antiplatelet treatment. ,
  • For suspected TIA within the last week, offer immediate aspirin 300 mg daily unless contraindicated, and refer for specialist assessment and investigation to be seen within 24 hours of symptom onset. ,
  • Do not use scoring systems such as ABCD2 to assess risk or urgency of referral for suspected or confirmed TIA. ,
  • Record detailed clinical history including symptom onset, evolution, and neurological examination findings.
  • Assess vital signs including pulse, respiratory rate, blood pressure (lying and standing if appropriate), and perform a 12-lead ECG to identify any cardiac abnormalities that may influence management.

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