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■ Inability to protrude tongue and/or move it from side to side
■ Aphasia (difficult to speak or understand language)
■ Apraxia (altered voluntary movements)
■ Vertigo and disequilibrium, with difficulty walking, altered movement
coordination, and arm drift
■ Urinary and fecal incontinence
Complications
■ Physical: pressure sores, incontinence, pneumonia, seizures, coma, and
death
■ Emotional: anxiety, panic attacks, flat affect, depression, withdrawal, sleep
disturbances, lethargy, irritability, and emotional lability
Diagnostic Tests
■ The timing and use of diagnostics highly depends on the time of admission
and on whether the patient is a candidate for rtPA or is post-procedure rtPA.
■ Calculate NIH Stroke Score for quantifying stroke severity:
■ http://reference.medscape.com/calculator/nih-stroke-score
■ http://www.mdcalc.com/nih-stroke-scale-score-nihss/
■ CBC with platelet count
■ Serum chemistry including electrolytes, glucose and renal function tests;
consider hepatic function tests
■ Coagulation studies
■ Cardiac biomarkers, especially troponin
■ Toxicology screen and blood ETOH level if indicated because stroke
symptoms may mimic substance abuse
■ Pregnancy testing
■ Noncontrast brain CT or brain MRI
■ CXR if lung disease suspected
■ CT/MRI perfusions and diffusion imaging
■ Carotid artery vascular ultrasound or carotid Doppler ultrasound
■ ECG, especially if atrial fibrillation suspected
■ Consider EEG, especially if seizure activity present; consider lumbar
puncture if SAH or CNS infection suspected
■ O 2 saturation and ABGs if suspected hypoxia
■ Vascular imaging: CTA, intracranial MRA, TCD ultrasonography, DSA,
conventional angiography

NEURO