In pre-hospital care, few diagnoses carry the same urgency as stroke. But not all strokes present the way we expect, and that’s where the risk lies. In this episode, we explore the challenge of recognising posterior circulation strokes, using both clinical insight and lived experience. I’m joined by Shane Devlin, a registered paramedic and newly appointed PhD researcher focusing on posterior stroke recognition. His work builds on frontline experience and a growing body of evidence that highlights just how easily these patients can be missed.

Alongside Shane, this conversation is grounded in a personal story: my brother, Ronan Walker, who suffered a posterior stroke 4 years ago in his late 30's. His presentation didn’t fit the traditional mould. There was no clear FAST-positive picture, just subtle, evolving symptoms that required a different kind of clinical suspicion.

This episode sits at the intersection of science and story. We unpack the limitations of current assessment tools, the cognitive challenges clinicians face in the field, and what needs to change to improve recognition. Because in a posterior stroke, the issue often isn’t treatment, it’s getting patients to treatment in time.

Shane has published both case studies and qualitative research on PCS. Both can be found here: Paramedic recognition of posterior circulation stroke: a vignette and focus group study

https://pubmed.ncbi.nlm.nih.gov/37674916/

Not so FAST: pre-hospital posterior circulation stroke:

https://pdfs.semanticscholar.org/06a1/f16d9062708b6f4ff8bb29efb7d9a61b43db.pdf

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