Cerebrovascular disease

Cerebrovascular disease can present as stroke, transient ischaemic attack or amaurosis fugax, due to vaso-occlusive disease in the cerebral circulation, usually due to emboli from carotid atheroma plaques. Diagnosis is on clinical grounds +/- imaging and managment should focus on primary and secondary prevention as much as possible.

General examination

A thorough general and systems examination is an essential part of the assessment of any patient with a diabetes complication. 

Cardiovascular

Assess for signs of cardiac failure, which may be due to previous myocardial infarction.

Is the patient hypertensive? Is the patient in atrial fibrillation which may arouse suspicion of cardiac emboli underlying the presentation? Are there carotid bruits?

Neurological examination

A full and thorough neurological examination including cranial nerves, speech, limbs (power, tone, coordination, reflexes and sensation), gait and fundoscopy should be performed in all patients with suspected stoke, TIA or amaurosis.

Swallowing

Patients who have ongoing symptoms (i.e. stroke in evolution), should have their swallowing assessed by carefully observing them swallowing a small amount of water and assessing for coughing/choking afterwards and listening to speech to assess for any retained liquid in the pharynx.

This should be followed up by a more detailed swallow assessment by a speech therapist later.

Examine the entire arterial tree

The presence or absence of all arterial pulses should be documented i.e. the radial, brachial, carotid, femoral, popliteal, dorsalis pedis and posterior tibial. In addition, carotid, renal and femoral arteries should be auscultated for presence of arterial bruits.

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