DIAGNOSIS OF STROKE AND STROKE MIMICS IN THE EMERGENCY SETTING

Stroke Scales as Assessment Tools in Emergency Settings: A Narrative Review

In the last 20 years, substantial improvements have been made in stroke recanalization treatment. Good outcomes after modern reperfusion treatment require the rapid and accurate identification of stroke patients. Several stroke rating scales are available or have been proposed for the early recognition of stroke and the evaluation of stroke severity and outcome. This review aims to provide an overview of commonly used stroke scales in emergency and clinical settings. The most commonly used scale in a prehospital setting for stroke recognition is the Face, Arms, Speech, Time (FAST) test. Among many prehospital stroke scales, the Los Angeles Prehospital Stroke Screen has the highest sensitivity and specificity for confirming stroke diagnosis. The National Institutes of Health Stroke Scale (NIHSS) is the most recommended tool for the evaluation of stroke patients in hospital settings and research, and it has two variants: the shortened NIHSS for Emergency Medical Service and the modified NIHSS. The evaluation of comatose patients usually involves assessment with the Glasgow Coma Scale, which is very useful in patients with hemorrhagic stroke or traumatic brain injury. In patients with subarachnoid hemorrhage, the outcome is usually accessed with the Hunt and Hess scale. A commonly used tool for stroke outcome evaluation in clinical/hospital settings and research is the modified Rankin scale. The tools for disability evaluation are the Barthel Index and Functional Independence Measure.

Screening for medical disease--nervous system disorders

NARRATIVE REVIEW: In general, nervous system disorders present with changes in sensation, strength, and cognitive function that must be recognized early for the timely referral often needed for optimal outcome. This article summarizes screening for nervous system disorders in patients who present to the hand therapist and the typical findings associated with common neurologic disorders. Recommendations for referral by the hand therapist of patients with a screening examination consistent with a nervous system disorder are also presented. Central nervous system (CNS) disorders discussed in this article include stroke, traumatic brain and spinal cord injury, CNS tumors, Parkinson disease, dementia, epilepsy, and multiple sclerosis. This is followed by a discussion of the peripheral nervous system (PNS) disorders of acquired and hereditary polyneuropathies, Guillain-Barré syndrome and myasthenia gravis. Lastly, there is a brief discussion of amyotrophic lateral sclerosis, a disorder affecting both the CNS and PNS.

LEVEL OF EVIDENCE

5.