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Revisit history taking to identify risk factors for stroke and explore relevant medical history. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. The oldest person to have lived, Jeanne Calment, reached 122, though she was perhaps not the greatest example of good health: she smoked until she was 117. The most successful life-extension methods we know of seem to be those we have known all along: eat well, sleep well, exercise, reduce stress and rely on modern medicine, which has prolonged average lifespans significantly over the past 160 years. The Bamford stroke classification divides the different types of stroke into TACS, PACS, POCS and LACS, depending on the clinical features. Alert a senior immediately if you have any concerns about the consciousness level of a patient. A GCS of 8 or below warrants urgent expert help from an anaesthetist. In the meantime, you should re-assess and maintain the patient’s airway as explained in the airway section of this guide. CPR A LACS (lacunar stroke) is subcortical; therefore, higher cerebral functions (e.g. language) are preserved. Hence, these can be pure motor, sensory, sensorimotor, or cause ataxic hemiparesis alone. 3 Bamford stroke classification Haemorrhagic stroke

Well done, you’ve now stabilised the patient and they’re doing much better. There are just a few more things to do… Take a history There are several conditions which can mimic a stroke. When assessing a suspected stroke patient, it is important to consider these differentials. All patients seen with an acute neurological syndrome suspected to be a stroke should be transferred directly to a specialised hyper-acute stroke unit that will assess for thrombolysis and other urgent interventions and deliver them if clinically indicated.Are we anywhere near to a breakthrough? So far, research has produced modest yields. Gerontologists speak prophetically of potential, but most warn a significant human development remains somewhere far off in the distance – almost in sight but not quite. Richard Hodes, the director of the National Institute of Aging, a US government agency, told me that, though research in animals has led to “dramatic increases in lifespan”, some of them multi-fold, “There has been far less quantitative effect as those models have moved towards mammalian species.” The biologist Laura Deming, who in 2011 established the Longevity Fund, a venture capital firm that supports “high-potential longevity companies”, told me that startups continue to successfully root out biological markers of ageing – inefficient cells, mitochondrial decline – but that, in humans, “We really don’t know right now what will work and what won’t.” Someone in the UK will have a stroke every 5 minutes, with 100,000 people having strokes yearly. Cerebrovascular diseases are the 4 th most common cause of death in the UK, with 75% of those deaths being from stroke. 1 If you spot any of these signs of a stroke, don't wait. Call 999 straight away. How long do symptoms last? Terminal internal carotid, middle cerebral artery (M1 or proximal M2) occlusion or basilar artery occlusion

Further investigations will depend on the clinical context and may be required to exclude stroke mimics. Interventions Repeat administration of fluid boluses up to four times (e.g. 2000ml or 1000ml in patients at increased risk of fluid overload), reassessing the patient each time. Thrombolysis involves administering a thrombolytic agent (e.g. alteplase) to break down a clot. Thrombolysis can be used in patients with an ischaemic stroke who present within 4.5 hours of symptom onset. Ambulance paramedics are trained in stroke and will ensure the person receives emergency medical care and specialist treatment. Other symptoms of a stroke If the patient is unconscious or unresponsive, start the basic life support (BLS) algorithm as per resuscitation guidelines.In some patients who receive early imaging, the thrombus or embolus may be visible within the vessel. This appears as hyperdensity within the vessel (e.g. hyperdense middle cerebral artery). Open the patient’s mouth to ensure there is no foreign material that may be pushed into the larynx. If foreign material is present, attempt removal using suction. A blood glucose level may already be available from earlier investigations (e.g. ABG, venepuncture). De Grey shares Strole’s belief that innovations are coming. But, unlike Strole, he considers current strategies almost pointless. He does not take hundreds of supplements. He does not pay for stem-cell transfusions. “I want to wait and see,” he says. At 56, he is content to sit tight for treatments that have become “progressively more effective… so I don’t have to use clunky, first-generation therapies that may have side-effects.”