Clinical presentation

At 16:24, an ambulance was asked to attend an 18-year-old man found collapsed at home. First responders arrived at the patient's house at 16:30, followed by a paramedic ambulance at 16:45. Paramedics along with the patient and his sister left the house at 17:04 in a blue-light ambulance and arrived at our acute stroke service at 17:15.

His sister said that he had spoken normally on the phone at approximately 13:00. A friend had phoned at 16:15 and found his speech was ‘slurred’, so went to his house, found him face down on the floor and called an ambulance. Paramedics found him alert with normal vital signs. Pupils were equal and reactive but speech was very slurred, and there was right face, arm and leg weakness.

On arrival at hospital, he was alert with eyes open but severe dysphasia was present and he was limited to making incomprehensible sounds and following very simple instructions with visual …