Screenings after a stroke or TIA

Checks in hospital

NICE says that on admission, people with acute stroke should have their swallowing screened by an appropriately trained healthcare professional before being given any oral food, fluid or medication, and that if the screen shows problems, the person should have a specialist assessment of swallowing, preferably within 24 hours of admission and not more than 72 hours afterwards. (NICE NG128) NICE also lists screening in hospital for disorientation, movement, pressure area risk, continence, communication, and nutrition and hydration. (NICE NG236)

NICE says to perform a full medical assessment after stroke, including cognition (attention, memory, spatial awareness, apraxia of speech, perception), vision, hearing, muscle tone, strength, sensation and balance. (NICE NG236) The NHS says tests to diagnose a stroke include blood tests, CT, MRI and ultrasound scans, and an electrocardiogram (ECG) to check your heart. (NHS diagnosis) MedlinePlus says the provider will check for high blood pressure and an irregular heartbeat, and lists an ECG and heart rhythm monitoring among the tests. (MedlinePlus)

Review at 6 months and then every year

NICE says to review the health and social care needs of people after stroke, and the needs of their carers, at 6 months and then annually, and that these reviews should cover participation in activities of everyday life. (NICE NG236) The NHS says that after about 6 months you should get a review of your progress, and if you do not get this, to speak to your team about it. (NHS recovery) NICE ties these checks to the 6-month and annual reviews: (NICE NG236)

new or persisting changes to mood or emotional difficulties
persisting communication difficulties
the person's information needs
the training and support needs of family members and carers
a standardised fatigue assessment to consider at the 6-month review

See questions to ask your doctor.

Mood, memory and thinking

NICE says a comprehensive assessment after stroke should take into account mental health, for example the onset of depression, anxiety or post-traumatic stress disorder, including signs of an increased risk of suicide, and the way the person is adjusting and coping. (NICE NG236) MedlinePlus says many people develop depression after a stroke. (MedlinePlus) NICE says to screen people after stroke for cognitive impairment, and where it is found, to carry out a detailed assessment using valid, reliable and responsive tools. (NICE NG236) See depression screening: what to expect, mental health screenings by age and memory screening (Mini-Cog and MoCA).

Hearing and vision

NICE says to screen people for hearing problems within the first 6 weeks after stroke, to consider the Handicap Hearing Inventory in the Elderly or Amsterdam Inventory Auditory of Disability questionnaires, and to ask the person, and their family members and carers, about any changes to their hearing since the stroke. (NICE NG236) It says to offer people in hospital after stroke a specialist orthoptist assessment as soon as possible, or an urgent outpatient appointment if this cannot be done before discharge. (NICE NG236) See hearing tests by age and eye exams by age.

Swallowing and falls

NICE says to assess swallowing in people after stroke in line with its stroke and TIA guideline, and to give people with stroke, and their families and carers, information to recognise complications, including frequent falls. (NICE NG236) See fall risk screening.

Heart rhythm, blood pressure, cholesterol and blood sugar

NICE says to feel the pulse by hand to check for an irregular pulse when atrial fibrillation is suspected, including in people presenting with stroke or TIA, and to do a 12-lead ECG if an irregular pulse is found. (NICE NG196) The NHS lists high blood pressure, diabetes, atrial fibrillation (irregular and fast heartbeats), high cholesterol and a TIA among the conditions that increase the risk of stroke. (NHS causes) For preventing another stroke, NICE points to its guidelines on cardiovascular disease, high blood pressure, type 2 diabetes and atrial fibrillation. (NICE NG236) See atrial fibrillation screening, screenings if you have high blood pressure, cholesterol test by age and A1C and blood sugar test results.

Carotid artery imaging after a TIA

NICE says everyone with TIA who, after specialist assessment, is considered a candidate for carotid endarterectomy (surgery to clear a narrowed neck artery) should have urgent carotid imaging. (NICE NG128) MedlinePlus lists carotid duplex (ultrasound), to see if the carotid arteries in the neck have narrowed, among the tests after a stroke. (MedlinePlus) This is a test after symptoms, not screening of people without symptoms. See carotid artery screening.

Usual screening on schedule

A stroke or TIA does not change the general schedules for cancer and other screening in the sources on this page. (NICE NG236)(MedlinePlus) See preventive screenings for older adults, cancer screenings by age and screenings by age and gender.

When to contact a provider

MedlinePlus, stroke, when to contact a medical professional: (MedlinePlus)

Stroke is a medical emergency that needs to be treated right away. The acronym F.A.S.T. is an easy way to remember signs of stroke and what to do if you think a stroke has occurred. The most important action to take is to call 911 or the local emergency number right away for emergency assistance.

F.A.S.T. stands for:

FACE. Ask the person to smile. Check if one side of the face droops.
ARMS. Ask the person to raise both arms. See if one arm drifts downward.
SPEECH. Ask the person to repeat a simple sentence. Check if words are slurred and if the sentence is repeated correctly.
TIME. If a person shows any of these symptoms, time is essential. It is important to get to the hospital as quickly as possible. Call 911 or the local emergency number. Act F.A.S.T.

Where they differ:

When the review happens. NICE sets a review at 6 months and then every year; (NICE NG236) the NHS page names the review at about 6 months and tells you to ask your team if it does not happen. (NHS recovery)
Heart rhythm checks. NICE NG196 starts with feeling the pulse by hand and an ECG if it is irregular; (NICE NG196) MedlinePlus lists an ECG and heart rhythm monitoring among the tests after a stroke. (MedlinePlus)

Your doctor decides what your result means for you.

Questions people ask

How often is a review offered after a stroke?

NICE says to review the health and social care needs of people after stroke, and the needs of their carers, at 6 months and then annually. The NHS says that after about 6 months you should get a review of your progress, and if you do not get this, to speak to your team about it. (NICE NG236) (NHS recovery)

Which checks come up at the 6-month and yearly reviews?

NICE ties several checks to these reviews: new or persisting changes to mood or emotional difficulties, persisting communication difficulties, information needs, and the training and support needs of family members and carers. It says to consider a standardised assessment for fatigue at the 6-month review. (NICE NG236)

Is hearing checked after a stroke?

Yes. NICE says to screen people for hearing problems within the first 6 weeks after stroke, to ask the person, and their family members and carers, about any changes to their hearing since the stroke, and to consider the Handicap Hearing Inventory in the Elderly or Amsterdam Inventory Auditory of Disability questionnaires. (NICE NG236)

Does a stroke change the usual cancer screening schedule?

The sources on this page do not set a different schedule for cancer or other routine screening in people who have had a stroke or TIA. (NICE NG236) (MedlinePlus)