Perform a systematic examination — mental status, cranial-nerve screen, motor strength graded 0–5 by group with symmetry, pronator drift, a sensory screen, coordination, and gait.
Screen for acute stroke with F.A.S.T. (facial droop, arm weakness, speech difficulty, time) or BE-FAST (adding balance and eyes), and establish the time the patient was last known well.
Compare every finding to the patient's neurologic baseline drawn from prior visits.
Recognize an acute focal deficit as a potential emergency and act immediately; note that time is the critical variable in stroke care.
Assess for seizure activity and post-ictal state, and screen headache for emergency features.
