How to Recognize a Stroke

Think FAST

A stroke is sometimes referred to as a brain attack. It's often caused by a blood clot in an artery of the brain, blocking the flow of oxygen and nutrients to parts of the brain tissue. This type is called an ischemic stroke. Ischemic refers to restricted blood flow. Without the oxygen and sugars that blood brings, the brain cells begin to die very quickly.

Within minutes of a stroke, signs and symptoms may appear. If these signs and symptoms are identified rapidly, there are important treatment options that can interrupt the damage before it becomes permanent or completely disabling.

To help you recognize whether you or someone else is having a stroke, remember to think FAST:

  • Face
  • Arms
  • Speech
  • Time

There is another type of stroke, called a hemorrhagic stroke. In this case, a blood vessel in the brain ruptures and bleeds. hemorrhagic strokes are less likely to respond to current treatments and some treatments can actually make them worse. It's impossible to tell the difference between an ischemic stroke and a hemorrhagic stroke without a CT scanner, which makes fast recognition of stroke signs that much more important.


Bells Palsy is an infection of the facial nerves. It's not a stroke, but the droop is similar. Koshy Johnson/Getty Images

Our brains have two sides, split evenly down the middle. The left side of the brain controls the muscles on the right side of the body, and vice versa. Since a stroke damages a relatively small area of the brain, it usually affects only one side.

This causes asymmetrical weakness, which shows up most obviously in the face and the arms. When the muscles of the face get weak, the face becomes slack (unable to move). There are a few causes, but stroke is the most dangerous.

One of the most common tests for facial droop (the common term for asymmetrical facial expression) is to have the patient smile. In the picture above, the woman has an inflammation of her facial nerve. It's called Bells Palsy and is not life threatening, but it shows you what to look for in a stroke.


Stroke Week on One Side
Only being able to lift one arm can be a sign of stroke. Science Photo Library/Getty Images

Being able to lift one arm and not the other is an indication that one side of the brain is working and the other side isn't. It's called asymmetrical weakness, which simply means one side is weaker than the other. You can see it in the face as well.

One way to test for asymmetrical weakness is to have the patient put his outstretched directly in front of him and close his eyes. Ask him to hold his hands there. If one arm drifts down, it's a sign that he is weak on one side.

Let's be clear: Weakness on one side is a sign of stroke; it doesn't have to be specifically in the arms. Another test can be to have the potential stroke patient squeeze your hands. If one hand is able to grip while the other is not, it's still asymmetrical weakness.


Confused man
Aphasia is the inability to speak, often brought on by a stroke. drbimages/Getty Images

 Inability to speak, slurred speech or using incorrect words are all common signs of stroke. If the damage in the noggin is affecting the areas of the brain responsible for speech, there can be all sorts of weird symptoms.

Slurred speech or trouble finding words is known as dysphasia, while the complete inability to speak is known as aphasia. Sometimes, the slurred speech is not because there is damage to the brain's speech center, but because there is severe facial droop affecting the patient's ability to move her mouth or tongue.

One thing to keep in mind as you're assessing a potential stroke patient: He or she is probably not confused. Stroke patients often report that during their events, they were able to completely understand everything that was happening even if they weren't able to communicate verbally.


Seconds count during a stroke. Mike Good/Getty Images

There aren't too many medical conditions where minutes really count. Sudden cardiac arrest, severe hemorrhage, brain injuries and strokes are just about the only ones. Everything else, even heart attacks, can at least be measured in hours.

There is a very short window of time when treatment can help a stroke. The brain is very delicate and brain tissue rarely repairs itself (we used to say it never happens, but there have been rare examples of complex nerve tissue regeneration). Even when it does heal a little, major damage is not going to disappear.

The big concern with a stroke is the residual weakness and dysphasia that will linger after the blood clot is gone. If a stroke is recognized and treated quickly, the amount of damage can be limited or possibly even reversed. However, the timeline is tight. Because this is a moving target as medical care evolves and improves, and because I don't want to discourage anyone from seeking treatment, I won't say how long is too long. The message here is to call 911 as soon as you believe you or someone else is having a stroke.

Think and act FAST!

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