Early assessment allows the formulation of an accurate and early diagnosis (as stroke is primarily a clinical diagnosis, the sooner a physician can elicit a history, the more likely it is to be reliable), the organisation of relevant and cost effective investigations, and the initiation of appropriate secondary prevention (which is likely to be most effective early on, when the risk of recurrence is highest). However, as with any medical emergency, the first priority in assessing a patient following a suspected stroke is to identify and treat any immediately life threatening complications. For stroke, this will usually be an obstructed airway (A), respiratory failure in a comatose patient (B), or an acute circulatory disturbance (C). Once the patient is stable, we apply a systematic, staged approach to making the diagnosis and formulating a management plan. This initial assessment should address the following questions.

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