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Stroke and transient ischaemic attack - Management
Follow up and assessment of people with a history of stroke or TIA
How should I follow up someone who has had a stroke or TIA?
Planned follow up:
- Local arrangements should make it clear how this is decided and where the person will be followed up.
- Follow-up arrangements and frequency depend on individual clinical needs and response to treatment. Where there are no problems requiring more frequent assessments:
- People who have had a stroke:
- Schedule primary care follow up (together with the carers) within 6 weeks of discharge, again within 6 months of discharge, and then annually.
- People who have had a transient ischaemic attack (TIA) or minor stroke:
- Follow up within 1 month of the event (in primary or secondary care) and then annually in primary care.
Management:
- Assess the need for further specialist review, advice, information, support, and rehabilitation — see Referral guidance.
- Assess social care needs.
- Assess health care needs — see Assessment.
- Check and optimize lifestyle measures and drug treatments for secondary prevention:
- Check and record annually blood pressure and lipid profile.
- Arrange for annual pre-winter influenza immunizations.
In depth
How should I assess a person who has a history of stroke?
- When people with a history of stroke consult (for whatever reason), be alert for problems that may require new assessment and management:
- Neurological problems — balance, movement, tone, sensation, power.
- Pain — neuropathic, shoulder pain and subluxation, musculoskeletal pain.
- Mood and social interaction problems — depression, anxiety, emotionalism, disinhibition, aggression.
- Cognitive impairments:
- Attention and concentration.
- Memory.
- Disturbances of spatial awareness — neglect.
- Disturbance of perception — visual agnosia.
- Apraxia — loss of the conceptual ability to organize activities to achieve a goal.
- Planning, organizing, initiating, and monitoring behaviour (i.e. disturbances of executive functioning).
- Speech and communication difficulties — aphasia, dysarthria, apraxia of speech.
- Visual impairments and hemianopia.
- Bladder and bowel problems — urinary incontinence, faecal incontinence, constipation.
- Swallowing and nutrition problems — oral health, malnutrition, dehydration, artificial feeding.
- Sexual dysfunction.
- Difficulties with activities of daily living — personal, social, and vocational:
In depth
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