**3. Clinical presentation**

Patients present with abrupt onset of focal neurological deficit such as facial paresis, arm drift, leg weakness and abnormal speech [13]. Although patients with acute ischaemic stroke do present with headache, vomiting, seizures, depressed level of consciousness; these symptoms are commoner in patients with haemorrhagic stroke. It is difficult, on the basis of clinical presentation, to distinguish intracerebral haemorrhage from ischaemic stroke as they may look alike [14]. The duration of stroke onset should be noted as this is crucial in defining treatment options. Past medical and drug history (e.g heroin, amphetamines, and cocaine) should be obtained. History of vascular risk factors such as obesity, hypertension, hyperlipidaemia, diabetes mellitus, and smoking should also be obtained. The initial neurological assessment of the patient should be brief but detailed. Different stroke scales such as National Institutes of Health Stroke Scale (NIHSS) can be employed as this helps in determining the severity of the stroke [15]. Assessment of airway, breathing and circulation may precede a thorough evaluation of the stroke patient. A comprehensive physical examination is carried out by the attending physician or the stroke team. This may reveal an irregular pulse, bradycardia, cardiomegaly or heart murmurs. The blood pressure should also be checked [16].
