Neurological examinations performed in the case of suspected circulatory disturbance

1. Big picture

In suspected cerebral circulatory disturbance — acute ischemic stroke, transient ischemic attack (TIA), intracerebral hemorrhage, subarachnoid hemorrhage, vertebrobasilar insufficiency — the neurological examination has two urgent aims:

1. Recognize that the symptoms are vascular. Stroke usually causes sudden focal neurological deficit.

2. Localize the lesion and estimate severity. The examiner must decide whether the syndrome suggests:

   • anterior circulation / carotid territory,

   • posterior circulation / vertebrobasilar territory,

   • cortical, subcortical, brainstem, cerebellar, or spinal localization,

   • large-vessel occlusion,

   • stroke mimic.

The neurological examination does not reliably distinguish ischemia from hemorrhage. That is why urgent brain imaging, especially native cranial CT ± CT angiography, is essential before specific acute stroke treatment.