Stroke Symptoms: How to Recognise One in Seconds

The FAST test

Four checks, a few seconds each:

• F — Face. Ask them to smile. Does one side of the face droop?
• A — Arms. Ask them to raise both arms. Does one drift down, or not lift at all?
• S — Speech. Ask them to repeat a simple sentence. Is speech slurred, or are they using the wrong words, or unable to speak?
• T — Time. If any of these are present, it is time to call 108 immediately.

Any one of the first three is enough. You do not need all of them.

Other symptoms that count

Stroke does not always present with the classic three:

• Sudden loss or blurring of vision, in one or both eyes
• Sudden severe dizziness, loss of balance or inability to walk
• Sudden numbness on one side of the body
• A sudden, extremely severe headache unlike any previous headache — this can indicate bleeding in the brain
• Sudden confusion, or difficulty understanding what is being said
• Difficulty swallowing, or a drooping mouth

The common thread is sudden onset of a neurological deficit. Gradual symptoms over days are a different problem; sudden ones are a stroke until proven otherwise.

What to do immediately

1. Call 108. Say clearly that you suspect a stroke — it changes how the call is prioritised
2. Note the time symptoms began, as precisely as you can. If they woke with symptoms, note when they were last seen normal
3. Keep the person still, sitting or lying with the head slightly raised
4. Do not give food, water or medicine — swallowing is often impaired, and fluid can go into the lungs
5. Loosen tight clothing and stay with them
6. Gather their medicines and any recent reports, if someone else can do it
7. If they become unresponsive and are not breathing normally, start chest compressions

What not to do

• Do not wait to see if it improves. Symptoms that come and go are still an emergency
• Do not give aspirin. Unlike a heart attack, some strokes are caused by bleeding, and aspirin makes those worse. Let the hospital decide after imaging
• Do not attempt home remedies — the practice of pricking fingers, applying oils, or waiting for a neighbour's opinion costs brain tissue every minute
• Do not drive yourself. Ever

Why time is everything

An ischaemic stroke — the commonest kind — is a blocked artery in the brain. Brain tissue downstream begins dying within minutes, and roughly two million neurons are lost per minute of delay.

The treatments that reverse a stroke, rather than merely managing it, are only possible within a narrow window from symptom onset. That window is measured in hours, not days, and it closes.

Almost all of the delay in stroke care happens before arrival at hospital — deciding whether it is serious, calling a relative, waiting for morning. That is the part that is within a family's control, and it is the part that most determines whether someone walks out of hospital.

Mini-strokes are warnings

A transient ischaemic attack, or "mini-stroke", causes the same symptoms but they resolve within minutes to hours. It feels like a false alarm. It is not.

A TIA carries a substantially raised risk of a full stroke in the following days and weeks, and that risk is markedly reduced by prompt assessment and treatment. Symptoms that resolved completely still need same-day medical attention.

Reducing your risk

Most strokes are preventable, and the levers are the same ones as for heart disease:

• High blood pressure is the single biggest modifiable risk factor. Treating it well is the highest-value thing most people can do
• Atrial fibrillation — an irregular heart rhythm — greatly raises stroke risk and is treatable once identified. If your pulse is irregular, get it checked
• Diabetes and high cholesterol
• Smoking — quitting reduces risk substantially within a few years
• Excess alcohol, physical inactivity and untreated sleep apnoea

Our neurology department manages stroke care and secondary prevention, working with the emergency department and intensive care unit on the same site.