Assessment: The presentation of sudden right-sided numbness, paresthesia, and weakness suggests a possible acute stroke or transient ischaemic attack (TIA) and requires urgent evaluation. Use a validated tool such as FAST to screen for stroke symptoms and exclude hypoglycaemia as a cause. Immediate neurological assessment is essential given the focal neurological deficits and symptom onset at 6:00 pm NICE CKS,NICE NG127,NICE NG128.
Measure oxygen saturation and note the hypoxia (SpO2 84% without oxygen). Supplemental oxygen should be administered to maintain SpO2 between 94% and 98%, unless there is risk of hypercapnic respiratory failure NICE CKS,NICE CKS,NICE NG128.
Management: Arrange immediate emergency hospital admission to a hyperacute stroke unit for urgent specialist assessment and brain imaging to exclude intracranial haemorrhage and confirm diagnosis NICE CKS,NICE NG128. Pre-alert the receiving stroke team with details of symptom onset, current condition, and medications including aspirin use NICE CKS,NICE NG128.
Do not delay transfer for aspirin administration if already given; continue aspirin if previously administered unless contraindicated NICE CKS,Products. Do not start anticoagulation until haemorrhage is excluded by imaging NICE CKS,NICE NG128. Monitor airway, breathing, and circulation while awaiting transfer, and provide oxygen to correct hypoxia NICE CKS,NICE NG128.
Exclude other causes of neurological symptoms if stroke is ruled out, and consider further neurological referral if symptoms persist or evolve NICE NG127.
Key References
- CKS - Chest pain
- CKS - Stroke and TIA
- NG127 - Suspected neurological conditions: recognition and referral
- CG95 - Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis
- NG128 - Stroke and transient ischaemic attack in over 16s: diagnosis and initial management
- Warfarin sodium SmPC
- Aspirin SmPC
- Atorvastatin SmPC
- Glyceryl trinitrate SmPC
- Iloprost SmPC