key points in History

History of present illness

• Last time patient known to be without symptom
• What was the patient doing when the symptoms began
• Any of the following: headache, seizures, vomiting, change in level of consciousness, recent trauma

Past Medical History:

• Risk factors for stroke: Age, HTN, CVA/TIA, Diabetes, Smoke, Atrial Fibrillation, hyperlipidemia, heart valve problem, illicit drug use.
• Medications: on warfarin, antiplatelet agent

Clues to underlying disease causing Stroke

• Fever: Suspect endocarditis, meningitis, brain abscess, other infection
• Recent neck injury, manipulation: Exam may show Horner's syndrome ipsilateral to stroke. Suspect arterial dissection
• Sudden onset headache: Suspect subarachnoid hemorrhage
• Thrombocytopenia, azotemia, purpura: Suspect TTP. May need blood smear, conjuctival biopsy, plasmapheresis
• Evidence of systemic emboli: Suspect cardiac/aortic source
• Recent angiography Suspect cholesterol emboli
• Drug abuse: Suspect endocarditis, amphetamine & cocaine related stroke. Need blood culture
• Post partum: Suspect hypercoagulable state
• Deep Vein Thrombosis, recent immobility: Suspect paradoxical embolus
• Chest and back pain: Suspect aortic dissection, check for asymmetric pulses.
• Recent Trigeminal nerve V1 zoster ipsilateral to stroke: Suspect granulomatous angiitis
• Livedo reticularis, history of spontaneous abortions: Suspect antiphospholipid syndrome. May need antiphospholipid antibody