What are the signs of a stroke and how is it treated?

Signs of Stroke and Treatment Approach

Recognizing stroke signs using the FAST acronym (Face drooping, Arm weakness, Speech difficulties, and Time to call emergency services) is critical for early identification, and immediate contact with emergency medical services (911) is strongly recommended for anyone experiencing these symptoms.

Signs and Symptoms of Stroke

Primary Signs (FAST)

• F - Face: Facial drooping or numbness, typically on one side 1
• A - Arms: Unilateral weakness or numbness in arms or legs 1
• S - Speech: Slurred speech, difficulty speaking, or language/speech disturbance 1
• T - Time: Note when symptoms began and call 911 immediately 1

Additional Signs

• Hemibody sensory symptoms (numbness/tingling on one side of body) 1
• Vision changes (monocular vision loss, hemifield vision loss) 1
• Symptoms of posterior circulation stroke:
  • Binocular diplopia (double vision)
  • Dysarthria (difficulty articulating words)
  • Dysphagia (difficulty swallowing)
  • Ataxia (lack of coordination) 1

Emergency Response Protocol

For the Public

1. Recognize stroke symptoms using FAST 1
2. Call 911 immediately, even if symptoms resolve 1
3. Note the exact time when symptoms began (last known well time) 1
4. Be prepared to provide relevant information to dispatchers and paramedics 1
5. Follow instructions from emergency medical dispatchers 1

For Emergency Medical Services

1. Use validated stroke assessment tools including FAST components 1
2. Determine the "last known well time" - critical for treatment eligibility 1
3. Perform rapid transport to a hospital capable of providing acute stroke care 1
4. Pre-notify the receiving hospital about the incoming stroke patient 1

Acute Hospital Management

Immediate Assessment (First Minutes)

1. Rapid evaluation of airway, breathing, and circulation 1, 2
2. Neurological examination using standardized scales (e.g., NIHSS) 2
3. Urgent brain imaging (CT or MRI) to distinguish between ischemic stroke and hemorrhage 2
4. Non-invasive vascular imaging (CTA or MRA) from aortic arch to vertex 1, 2
5. Essential bloodwork and 12-lead ECG 2

Acute Treatment

1. For eligible ischemic stroke patients:

   • Intravenous thrombolysis (tPA) within 4.5 hours of symptom onset 1, 2
   • Endovascular thrombectomy for large vessel occlusions within 6-24 hours in select cases 2

2. Blood pressure management:

   • For patients receiving tPA: maintain BP <180/105 mmHg for at least 24 hours 2
   • For patients not receiving tPA: medications typically withheld unless systolic BP >220 mmHg or diastolic BP >120 mmHg 2

3. Antithrombotic therapy:

   • Aspirin (325 mg initially) within 24-48 hours after stroke onset for patients not receiving thrombolysis 2
   • No aspirin within 24 hours of tPA administration 2

Supportive Care

1. Position patient in semi-recumbent position to prevent aspiration 2
2. Monitor and treat hypoxemia (oxygen therapy if O₂ saturation <92%) 3
3. Control blood glucose levels (treat if >8 mmol/L) 3
4. Early treatment of hyperthermia 3
5. Cardiac monitoring for at least 24 hours to detect atrial fibrillation 2
6. Neurological monitoring with serial examinations 2

Early Rehabilitation

1. Early mobilization when hemodynamically stable 2
2. Proper positioning to prevent contractures and pressure ulcers 2
3. Initiate rehabilitation within 24-48 hours for stable patients 2
4. Address cognitive and behavioral changes 2

Common Pitfalls to Avoid

1. Delay in seeking medical attention - Public education must emphasize that stroke is a medical emergency where "time is brain" 4
2. Failure to recognize posterior circulation strokes - These may present with less obvious symptoms like dizziness, balance problems, or visual disturbances 1
3. Missing the treatment window - Thrombolytic therapy effectiveness diminishes rapidly with time 5
4. Inadequate blood pressure management - Both extremely high and low blood pressure can worsen outcomes 3
5. Overlooking glucose control - Hyperglycemia is associated with poorer outcomes 3

Remember that stroke is a medical emergency requiring immediate attention. Every minute delay in treatment results in the loss of approximately 1.9 million neurons, making rapid recognition and response critical for improving outcomes 4.