What are the signs of a stroke?

Signs of a Stroke: Recognizing and Responding to this Medical Emergency

The most important signs of a stroke can be remembered using the FAST acronym: Face drooping, Arm weakness, Speech difficulties, and Time to call emergency services immediately. 1

Understanding Stroke Warning Signs Using FAST

The FAST acronym is recommended by the American Heart Association and the Canadian Stroke Best Practice Guidelines as an effective tool for recognizing stroke symptoms:

1. Face: Look for facial drooping or asymmetry when the person smiles

   • One side of the face may not move as well as the other side 1

2. Arms: Check for arm weakness or drift

   • Ask the person to raise both arms; one arm may drift downward or be unable to lift 1

3. Speech: Listen for speech abnormalities

   • The person may have slurred speech, use incorrect words, or be unable to speak 1

4. Time: Call emergency services (9-1-1) immediately

   • Even if symptoms resolve, immediate medical attention is crucial 1

Additional Stroke Symptoms

While FAST identifies approximately 88.9% of stroke cases 2, other important stroke symptoms include:

• Sudden severe headache with no known cause 1
• Visual disturbances (trouble seeing in one or both eyes) 1
• Balance problems (sudden trouble walking, dizziness, loss of coordination) 1
• Numbness or tingling (especially on one side of the body) 3
• Vertigo or dizziness (particularly in vertebral artery strokes) 4

Recognizing Stroke in Different Populations

In Children

Stroke in children may present differently than in adults. Common signs include:

• Hemiparesis (weakness on one side)
• Altered mental status
• Seizures
• Headache
• Ataxia (lack of muscle coordination)
• Nausea/vomiting 1

Adult stroke scores like FAST are not validated for pediatric populations and should not be solely used to identify stroke in children 1.

In Young Adults (18-55 years)

The FAST scheme identifies approximately 76.5% of strokes in young adults, with effectiveness increasing with age:

• 69.1% in 18-24 year-olds
• 77.8% in 45-55 year-olds 5

Importance of Immediate Action

Stroke is a medical emergency where minutes matter:

• Call 9-1-1 immediately when stroke symptoms are recognized 1
• Do not wait to see if symptoms resolve on their own 1
• Note the time when symptoms first appeared 1
• Be prepared to provide relevant information to emergency dispatchers 1

Why Rapid Recognition Matters

Early recognition and treatment of stroke significantly impact outcomes:

• Time-sensitive treatments like thrombolysis and endovascular therapy are most effective when administered promptly 1
• Patients arriving via emergency medical services receive faster evaluation and treatment 1
• The "stroke chain of survival" begins with rapid recognition of symptoms 1

Common Pitfalls in Stroke Recognition

1. Mistaking stroke for other conditions - Stroke can be confused with seizures, migraines, hypoglycemia, or conversion disorder 3

2. Waiting for symptoms to resolve - Even if symptoms disappear (as in a TIA or "mini-stroke"), emergency medical attention is still required 1

3. Missing posterior circulation strokes - FAST may identify fewer strokes in the posterior circulation (65.2%) compared to anterior circulation strokes 5

4. Delayed recognition in children - Stroke in children can present with nonspecific symptoms that mimic other childhood diseases 1

5. Language barriers - The terminology used in stroke campaigns may not always match how patients describe their symptoms 6

By knowing these signs and acting quickly, you can help ensure that someone experiencing a stroke receives the prompt medical attention that can significantly improve their chances of survival and recovery.