The Siriraj Stroke Score (SSS) is a clinical tool developed to differentiate between ischaemic and haemorrhagic strokes in settings where neuroimaging (CT/MRI) is unavailable. It uses clinical parameters to estimate stroke subtype, but its accuracy is limited and it is not recommended for routine use in the UK. Components of the Siriraj Stroke Score: The score incorporates: - Level of consciousness - Vomiting - Headache - Atheroma markers (history of hypertension, diabetes) - Diastolic blood pressure Calculation: SSS = (2.5 × level of consciousness) + (2 × vomiting) + (2 × headache) + (0.1 × diastolic BP) – (3 × atheroma markers) – 12 Interpretation: - Score > 1 suggests haemorrhagic stroke - Score < -1 suggests ischaemic stroke - Scores between -1 and 1 are indeterminate Limitations: - Sensitivity and specificity vary widely; reported sensitivity for haemorrhage ranges from 50–80% - Poor performance in elderly patients or those with mixed features - Cannot replace imaging, which remains gold standard for diagnosis - Risk of misclassification may lead to inappropriate treatment (e.g., thrombolysis in haemorrhagic stroke) Clinical relevance: In resource-limited settings without access to CT, SSS may guide initial management decisions. However, in the UK, NICE guidelines mandate urgent brain imaging before initiating specific treatments like thrombolysis.