ABSTRACT
The history must establish the presence of any relevant chronic illness, e.g. congenital heart disease or sickle cell disease. There may be a recent history of trauma, infectious disease or vaccination. A family or past medical history of migraine or epilepsy may be important. The mode of onset of the deficit and the presence of associated symptoms is also important, e.g. the sudden onset of headache with rapidly evolving hemiplegia may suggest an intracranial haemorrhage. Physical examination may reveal signs of a generalized bleeding disorder, trauma or local or systemic infection. Cardiological assessment, including blood pressure measurement, is mandatory (there may be extracardiac manifestations of infective endocarditis). Detailed neurological examination may establish the likely vessel of occlusion, e.g. a contralateral hemiparesis with legs affected more than arms in occlusion of the anterior cerebral artery. Cranial auscultation may reveal a bruit associated with an AV malformation.
