Management of Patient with Dizziness and Left-Sided Facial and Body Weakness

Risk Assessment

Patients with unilateral weakness and/or speech disturbance presenting within 48 hours of symptom onset are considered at VERY HIGH risk for recurrent stroke, according to the International Journal of Stroke guidelines 1, 2, 3
The risk of stroke after TIA can be as high as 10% within the first week of symptom onset, with the highest risk in the first 48 hours, as reported by the International Journal of Stroke 1, 4
Recent data shows that with rapid access to specialized care, stroke recurrence rates have decreased to approximately 1.5% at 2 days and 2.1% at 7 days, as stated by the International Journal of Stroke 4

The patient should be immediately transported to an emergency department with advanced stroke care capabilities, as recommended by the International Journal of Stroke 1, 2, 4
Urgent brain imaging must be completed without delay, including CT or MRI brain scan, as suggested by the Annals of Neurology and International Journal of Stroke 1, 2, 6
Non-invasive vascular imaging (CTA or MRA from aortic arch to vertex) should be performed, as recommended by the International Journal of Stroke 1, 3
An electrocardiogram (ECG) should be completed without delay, as stated by the Annals of Neurology and International Journal of Stroke 1, 3, 6
Basic laboratory investigations should include complete blood count, serum electrolytes and creatinine, and fasting blood glucose, as recommended by the Annals of Neurology 6

Carotid imaging (ultrasound, CTA, or MRA) should be performed to assess for carotid stenosis, as suggested by the Annals of Neurology, International Journal of Stroke, and Journal of the American College of Radiology 3, 6, 7

Cardiac assessment should include consideration of echocardiography (transthoracic and/or transesophageal) if a cardioembolic source is suspected, as recommended by the Annals of Neurology 8
Extended cardiac monitoring should be considered if paroxysmal atrial fibrillation is suspected, as stated by the Annals of Neurology 8

If significant carotid stenosis is identified, early carotid revascularization should be considered, as suggested by the International Journal of Stroke 3

Risk factor modification should be addressed, including blood pressure control, diabetes management, smoking cessation, and lipid management, as recommended by the International Journal of Stroke and Annals of Neurology 3, 4, 6, 8
Follow-up imaging may be necessary to monitor for disease progression, as stated by the International Journal of Stroke 3

The combination of dizziness with unilateral weakness strongly suggests a central rather than peripheral cause, as noted by the Praxis Medical Insights: Practical Summaries of Clinical Guidelines 5
Patients with multiple risk factors have a significantly higher risk of stroke following TIA, as reported by the International Journal of Stroke 4
Posterior circulation symptoms may be more subtle but carry similar risk for recurrent stroke, as stated by the International Journal of Stroke and Praxis Medical Insights: Practical Summaries of Clinical Guidelines 1, 5