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Although there are several advantages to starting secondary prevention immediately after ischaemic stroke,1 there are impediments to doing so. Minor stroke tends to present later than more severe stroke, and even in high-income countries, neurovascular clinic waiting times are generally too long and too few patients access the right type of brain imaging at the right time to exclude intracerebral haemorrhage (ICH)2 3; stroke services are even scarcer in lower-income countries. These shortcomings may well underestimate the frequency of ICH,4 as may beliefs that ICH presents with headache and tends to cause severe neurological impairment.
In settings where immediate radiological assessment is unavailable, a clinically based scoring system that “rules out” ICH could support clinical decisions to start secondary prevention immediately, pending CT within ∼8 days to confirm the stroke was ischaemic. Furthermore, a scoring system that identifies the possibility of …