A TACS (total anterior circulation stroke) is caused by an infarct affecting the areas of the brain supplied by the middle and anterior cerebral arteries, and it causes: Terminal internal carotid, middle cerebral artery (M1 or proximal M2) occlusion or basilar artery occlusion Stroke is a medical emergency. If you experience any of the symptoms below, you should call 999. How to identify a stroke Inspect the patient’s skin for evidence of bruising, which may indicate an underlying clotting abnormality (e.g. disseminated intravascular coagulation).

See our guides to recording and interpreting an ECG for more details. Interventions Intravenous fluids In some patients who receive early imaging, the thrombus or embolus may be visible within the vessel. This appears as hyperdensity within the vessel (e.g. hyperdense middle cerebral artery). Introduce yourself to whoever has requested a review of the patient and listen carefully to their handover. Interaction There are two kinds of haemorrhagic stroke, intracerebral haemorrhage (ICH) and subarachnoid haemorrhage (SAH): These investigations should not delay the emergency management of stroke, including arranging neuroimaging and thrombolysis (if indicated). Arterial blood gasIf a patient does meet these criteria, a referral should be made to the closest mechanical thrombectomy centre. Patients who do not fit the criteria for thrombolysis/thrombectomy There’s millions of people now who won’t see death if they choose,” said James Strole, the director of the Coalition of Radical Life Extension, an organization which brings together scientists and enthusiasts interested in “physical immortality”. The oldest person to have lived, Jeanne Calment, reached 122, though she was perhaps not the greatest example of good health: she smoked until she was 117. The most successful life-extension methods we know of seem to be those we have known all along: eat well, sleep well, exercise, reduce stress and rely on modern medicine, which has prolonged average lifespans significantly over the past 160 years. There are several conditions which can mimic a stroke. When assessing a suspected stroke patient, it is important to consider these differentials. Symptoms of stroke vary depending on the type of stroke and the area of the brain affected. For more information on history taking, see our guide to stroke and TIA history taking. Ischaemic stroke

The NIHSS is a systematic, quantitative assessment tool for stroke-related neurological deficits. The higher the number, the greater the deficit and the bigger the stroke. Auscultation of the heart may reveal irregular heart sounds suggestive of atrial fibrillation. Investigations and procedures Intravenous cannulation Look for signs of airway compromise: these include cyanosis, see-saw breathing, use of accessory muscles, diminished breath sounds and added sounds.Hypertension can cause stroke through end-organ damage (this is known as a hypertensive emergency and tends to occur at BP >200 mmHg systolic) A LACS (lacunar stroke) is subcortical; therefore, higher cerebral functions (e.g. language) are preserved. Hence, these can be pure motor, sensory, sensorimotor, or cause ataxic hemiparesis alone. 3 Bamford stroke classification Haemorrhagic stroke Administer a 500ml bolus of Hartmann’s solution or 0.9% sodium chloride (warmed if available) over less than 15 mins.