"Hello, I’m [Your Name], one of the doctors/nurses. I understand you've come in today because you've been experiencing some sudden symptoms that might be related to a stroke or TIA. Is that right?"
"Before we go any further, what are your thoughts about what might have caused these symptoms, or what it might mean?"
"And is there anything in particular that you're worried about, or anything you were hoping we could achieve during our conversation today?"
"Could you please tell me more about what happened? When exactly were you last known to be well or completely normal? This is a very important time for us to establish. If you woke up with the symptoms, did you get up at all in the night, perhaps to use the bathroom, and did you notice anything unusual then?"
"Was anyone with you when the symptoms started? If so, it would be very helpful if we could speak with them later, as their account might provide crucial details about the exact onset and what they observed."
"Could you describe the symptoms you experienced in as much detail as possible? Did you suddenly develop weakness or paralysis on one side of your face, arm, or leg?"
"Did you experience any sudden numbness, tingling, or a loss of sensation on one side of your body?"
"What about your vision? Did you have any sudden loss of vision in one eye, or double vision, or problems with seeing things in a certain part of your visual field?"
"Did you have any difficulty speaking, such as slurring your words, having trouble finding the right words, or difficulty understanding what others were saying to you? What about difficulty swallowing?"
"Did you experience any sudden loss of balance, dizziness, or feel like the room was spinning (vertigo)? Did you have any trouble walking or coordinating your movements?"
"How severe were your symptoms, and how did they affect you immediately? Were you able to move or speak normally?"
"How have your symptoms changed since they first started? Are they improving, getting worse, fluctuating, or have they completely resolved?"
"Have you had any recent head injuries or neck trauma, or perhaps any neck manipulation, that might have preceded these symptoms?"
"Did you have any other associated symptoms, like a headache (especially if it was very sudden and severe), fever, nausea, vomiting, seizures, or your heart racing (palpitations)?"
"Have you had any previous episodes with similar symptoms, even if they were brief or resolved quickly? If so, what happened then, and how were they diagnosed and managed?"
"Just to clarify, which is your dominant hand?"
"Are you experiencing any pain right now? If so, where is it, how would you describe it, and what makes it better or worse?"
"Are you experiencing any other symptoms anywhere else in your body? For example, any chest pain, shortness of breath, or leg swelling? What about any dizziness, balance issues, or seizures? Have you had any unexplained weight loss or fever?"
"Do you have any existing medical conditions? It's really important for us to know if you have any risk factors for stroke or TIA, such as high blood pressure, diabetes, high cholesterol, or a heart rhythm problem called atrial fibrillation (AF)? Have you had a previous stroke or TIA, or a heart attack? What about coronary artery disease, peripheral arterial disease, or carotid artery disease (narrowing of the arteries in your neck)? Do you have any known heart valve disease, or any clotting disorders? Do you suffer from migraines, particularly if they are associated with aura?"
"Have you ever had any operations or procedures, especially any heart, vascular, or brain surgery?"
"Are you currently taking any medications, including anything prescribed by a doctor, or any over-the-counter medicines, supplements, or herbal remedies? I'm particularly interested if you're taking any blood thinners like warfarin or DOACs, or antiplatelet medications like aspirin or clopidogrel. Are you on any medications for high blood pressure or cholesterol? What about oral contraceptives or hormone replacement therapy?"
"Are you taking your current medications regularly as prescribed?"
"Do you have any allergies to medications or anything else? If so, what kind of reaction did you have?"
"Does anyone in your close family – like your parents, siblings, or children – have a history of stroke, TIA, or heart disease, especially if it occurred at a young age? What about diabetes, high blood pressure, or inherited clotting disorders? If so, can you tell me at what age these conditions developed in your relatives?"
"Could you tell me a little about your living situation? What type of accommodation do you live in – are there stairs, for example? Who do you live with, and do you have a good support network around you? How do you manage with your daily activities, and how have these symptoms affected your ability to do them compared to before?"
"How about your lifestyle? Do you smoke, and if so, how much and for how long? How much alcohol do you drink in a week? Do you use any recreational drugs, particularly stimulants like cocaine or amphetamines, or have a history of intravenous drug use?"
"What's your typical diet like – is it high in salt or fat? How about your weight? Do you exercise regularly?"
"What kind of work do you do? If your job involves working at heights or with heavy machinery, I must advise you that you should not return to work until we have fully investigated the cause of your symptoms and deemed it safe."
"Regarding driving, it is very important that you do not drive until you have been fully investigated for your TIA or stroke. You will also have to inform the relevant driving authority (for example, the DVLA in the UK) about this event, as there are specific regulations about driving after a stroke or TIA."
"Thank you very much for sharing all of that information with me. Just to summarise, you've experienced [recap key symptoms], which started at [onset time] and have [recap evolution]. This has impacted you by [recap impact on ADLs]. You've also mentioned [recap relevant PMH/DH/FH/SH]."
"Does that sound like an accurate summary? Is there anything else you feel is important that we haven't covered?"
"Based on what you've told me, the next steps would be for me to perform a thorough physical examination, focusing on your neurological and cardiovascular systems, and checking your vital signs. We would also likely arrange for some investigations, such as blood tests (like a full blood count, kidney and liver function tests, glucose, lipids, and a clotting screen), an ECG (heart tracing), and imaging. This imaging might include a CT scan of your head, an MRI of your brain, a CT angiogram to look at your blood vessels, or a carotid Doppler scan to check the arteries in your neck. Depending on the findings, we would also refer you urgently to the stroke team or a TIA clinic for rapid assessment and management."
"Do you have any questions for me at this stage?"
"Thank you for your time."