Use the FAST test to screen for symptoms suggestive of acute stroke.

For people presenting with ongoing neurological symptoms suggestive of acute stroke

• Dial 999 to arrange emergency admission (unless admission would be inappropriate).

For people presenting with a history suggestive of a completed transient ischaemic attack (TIA)

• Refer for urgent specialist assessment:
• If they are at high risk of an early stroke, the target is to be seen within 24 hours of onset of symptoms:
• The risk of an early stroke is high if the ABCD2 score is 4 or more, or if there have been two TIAs within 1 week.
• If they are not at high risk of an early stroke, the target is to be seen within 1 week of onset of symptoms.
• Aspirin (300 mg daily) should be started immediately, unless it is contraindicated or not tolerated, and continued until the person is reviewed in secondary care.

Long-term care and support of people who have had a stroke or TIA

• All people should be followed up 1 month after the event, either in primary or secondary care, so that medication and other interventions to modify risk factors can be assessed.
• The role of primary care is to ensure that secondary prevention measures have been started and are being maintained and monitored, and that rehabilitation is progressing.
• Secondary prevention of stroke and other cardiovascular events involves:
• Lifestyle measures: stopping smoking; adopting a cardioprotective diet, including reducing salt intake; regular exercise; prudent use of alcohol; and achieving and maintaining a satisfactory body weight.
• Drug treatments: antithrombotic, antihypertensive, and lipid modifying treatments.
• The complications and consequences of stroke are diverse and may require referral to a wide range of services, for example speech and language therapy.