Clinical diagnosis of the acute stroke syndrome

To assist physicians without easy access to CT scanning facilities, a scoring system was devised to aid the clinical diagnosis of acute stroke. A consecutive series of 192 patients under 76 years was studied prospectively from admission. The clinical features of 174 (91 per cent) of these patients were compared with their subsequent CT scan or autopsy diagnosis. The scoring system derived from this analysis determines the relative likelihood of infarction or haemorrhage from quantitative assessment of eight clinical variables. Clinical diagnosis with this method was more accurate than the diagnosis made by the patients' physicians. Lumbar puncture performed in 72 patients added little to the accuracy of diagnosis. Nine patients were found to have mass lesions, of whom only one presented with a clear history. Convulsions and neurological deficits which were prolonged or discontinuous in evolution occurred more frequently in patients with mass lesions than in those with vascular lesions.