By definition, strokes happen suddenly. That’s why it’s crucial to know how to spot the signs that you or someone around you may be having one, experts say. Without fast treatment, strokes can lead to brain damage or death.
“There really is no warning sign prior to the stroke happening to indicate that a stroke is starting,” says Brandon Giglio, M.D., a vascular neurologist at NYU Langone Health. “The first symptom someone would experience would be the start of their stroke.”
The acronym BE FAST represents common signs of stroke and reinforces how important it is to act quickly by calling 911 if you notice stroke symptoms, Dr. Giglio explains. By calling 911 right away, you get the fastest possible access to professionals who can determine whether or not the symptoms are caused by a stroke, and if so, what type of stroke it is and what treatment is best.
How to recognize a stroke quickly
Memorize the BE FAST acronym:
B: Balance
Balance issues can manifest in a few different ways, says Erin Hansen, M.D., a primary care physician with Mercy Personal Physicians at Overlea. “That can be a sudden loss of balance, difficulty with coordination, trouble walking, or looking kind of off or unsteady while walking,” she explains.
E: Eyes
Vision changes may involve losing all or partial sight in one or both eyes, double vision, or sudden blurry vision, according to Dr. Hansen.
F: Face
Facial changes can include drooping, often on one side of the face. “A great way to assess that is to ask the person to smile, and that will really show you if there's some of that asymmetry or drooping on one side,” Dr. Hansen says.
A: Arm
Weakness in an arm or leg, usually on one side of the body, is a sign of stroke, Dr. Hansen warns. “A great way to assess for that is to ask the person to raise both arms up,” she says. “If they were able to raise one arm just fine and the other one doesn't move at all, that would be really severe. But, it might be that they're able to raise the arm, but then it drifts downward.”
S: Speech
Speech difficulties may include anything from slurred speech to difficulty getting words out, to not being able to speak at all, Dr. Hansen says. Difficulty understanding others’ speech and not being able to follow simple commands is also a sign that someone may be having a stroke.
T: Time
This may be the most important piece to remember: Act quickly. “The mantra a lot of us use is time is brain,” Dr. Hansen says. When a stroke happens, part of the brain doesn’t get enough oxygen, which then damages that part of the brain, she explains.
Speaking of the brain, Dr. Giglio adds that “someone having a sudden onset severe or worst headache of their life would be another possible stroke symptom.”
What to do if you notice stroke symptoms
Experts agree that promptly calling 911 is the best choice for someone experiencing one or multiple signs of a stroke.
It’s a common misconception that you should try to start treating the stroke at home with medications like aspirin, Dr. Giglio explains. This is because there are two types of stroke: hemorrhagic and ischemic, and the proper treatments for each stroke type differ. In a hemorrhagic stroke, a blood vessel in the brain bursts and bleeds. In an ischemic stroke, a clot in the brain’s blood vessels restricts blood flow.
Without imaging tests, it’s impossible to tell which type of stroke someone may be having. About 87% of strokes are ischemic, but in the event that someone is having a hemorrhagic stroke, taking an anti-coagulating medication like aspirin would only make the problem worse, according to Dr. Giglio.
When you call 911, paramedics can quickly assess vital signs that provide helpful information about a patient’s condition. They also will identify the best emergency room to transport the patient to, which will have a stroke response team at the ready, Dr. Hansen says.
What about ‘mini-strokes?’
Transient ischemic attacks (TIAs), also called “mini-strokes,” happen when blood flow to the brain is temporarily restricted, causing someone to experience stroke-like symptoms that go away within minutes to hours, Dr. Hansen explains.
It’s important to know that TIAs increase your risk for having a stroke, and about one-third of people who have a TIA will eventually have a stroke. That’s why it’s crucial to let your doctor know about any stroke-like symptoms you experience, even if they go away, Dr. Giglio emphasizes. For people who have had a TIA, “we certainly could prescribe medications that could significantly reduce their risk of a stroke happening,” Dr. Giglio says.
The bottom line
Someone having a stroke may have difficulty with balance, vision, speech, and controlling their face and limbs. If you or someone you are with shows any signs of stroke, call 911 immediately. “In that instant, you don't know whether it is a TIA, a stroke, or something else altogether,” Dr. Giglio says. The sooner you connect someone having a stroke with emergency resources, the sooner they can receive treatment to help their brain recover.
