TABLE 6.

Red flags (36, 42, 43).

History and symptoms ● Seizure-like activity, pseudo-seizures ● Rapidly progressing neurological signs with decreasing functional status ● Drop attacks or syncope not associated with orthostatic intolerance (e.g., HR and BP changes) ● Altered consciousness or memory, severe or frequent changes in cognitive status ● Increased bowel/bladder control dysfunction ● Headache worse with Valsalva maneuver ● Need to use a walker or wheelchair due to moderate or intermittently severe problems with coordination and balance rather than pain or weakness ● Symptoms significantly increased after MVA, whiplash, trauma Physical examination ● Abnormal central nervous system reflexes: Babinski, Hoffmann, clonus, hypertonia ● Abnormal cranial nerve findings: Altered visual field, eye movement, unequal pupil size, amblyopia (lazy eye), facial sensory loss ● Observed speech or swallowing dysfunction, choking, tongue dysfunction, sleep apnea (lower cranial nerves) ● Abnormal vertebrobasilar insufficiency tests with auditory and vision changes, evidence of vertigo, presyncope or syncope ● Ataxia, gross neurogenic gait abnormalities, inability to perform tandem gait, Romberg sign present ● Dysdiadochokinesia: e.g., rapidly alternating pronation/supination, grip release test, fast finger or foot tapping ● Dystonia, myoclonic jerking ● FASTER Indications of stroke: Face, Arms, Stability (standing), Talking, Eyes. R is for React.