Viva Practice for the FRCS(Urol) and Postgraduate Urology Examinations

Stroke is a treatable medical emergency affecting about 15 million people every year worldwide. It is the most common cause of common cause of disability globally and is the third most common cause of death. In the present times, there are effective treatment options which if given timely will benefit the patients of stroke remarkably. Therefore, correct diagnosis of acute stroke is extremely important for the clinicians to provide appropriate treatments and to ensure prevention of acute complications, including recurrent strokes. But sometimes a typical or uncommon presentation of stroke or “stroke chameleons”can lead to diagnostic dilemma. Therefore, timely diagnosis and management may be delayed. There are time – tested strategies which when strictly followed by the Neurphysician can reduce the chances of missing the correct diagnosis. Firstly, “Listen very carefully to the patient. He is telling you the diagnosis.” Clinicians should suspect stroke when the history suggests abrupt onset of neurological symptoms. Remember, Stroke is a clinical diagnosis and imaging is providing the corroboratory evidence. Secondly, a complete and systematic neurological examination should be routinely done in patients presenting with acute neurological symptoms because this might shed light on the true nature of the problem. Finally, even the most sophisticated neuroimaging tests might miss the stroke in the early hours after the event.