What immediate investigations should be performed in a patient presenting with suspected stroke in primary care?

In a patient presenting with suspected stroke in primary care, the immediate steps regarding investigations are primarily focused on initial screening and ruling out common mimics, followed by urgent referral to specialist care NICE NG128.

• Screening: Use a validated tool, such as FAST (Face Arm Speech Test), to screen people with sudden onset of neurological symptoms NICE NG128.
• Exclude Hypoglycaemia: It is crucial to exclude hypoglycaemia as a cause of sudden onset neurological symptoms NICE NG128.
• Immediate Referral: Everyone with suspected stroke should be admitted directly to a specialist acute stroke unit after initial assessment, from either the community, the emergency department, or outpatient clinics NICE NG128. Advanced brain imaging, such as non-enhanced CT, is performed immediately upon arrival at the specialist unit if there are indications for thrombolysis or thrombectomy, if the patient is on anticoagulant treatment, has a known bleeding tendency, a depressed level of consciousness, unexplained progressive or fluctuating symptoms, papilloedema, neck stiffness or fever, or severe headache at the onset of stroke symptoms NICE NG128. For suspected Transient Ischaemic Attack (TIA), CT brain scanning is not typically offered unless there is clinical suspicion of an alternative diagnosis that CT could detect NICE NG128.