Systematic approach to diagnosis and initial management of stroke

Stroke is a medical emergency with high rates of mortality and morbidity. Ischemic stroke should be distinguished from hemorrhagic stroke. Indicators of hemorrhagic stroke include coma, vomiting, severe headache, a systolic blood pressure greater than 220 mm Hg and a blood glucose level of 170 mg per dL (9.4 mmol per L). Essential elements of the physical examination include assessment of level of consciousness, speech, cognitive abilities, visual fields, extraocular muscle function, motor function and gait. Computed tomography or magnetic resonance imaging should be performed. The main goal of treatment is to maximize physical and cognitive function by limiting acute complications and facilitating rehabilitation. The role of the family physician is to stabilize the patient's condition, coordinate a multidisciplinary team and guide the patient, as well as the patient's family, through the process of recovery.