Features April 2013 Issue

Think FAST When it Comes to Stroke

Knowing the warning signs and how to react can make the difference between life and death.

While the risk of stroke increases with age and is the leading cause of long-term disability in the U.S., the damage cause by such an event can often be greatly minimized if symptoms are spotted early and appropriate steps are taken promptly.

To help raise public awareness of just what to look for and how to respond, the American Heart Association/American Stroke Association have launched an awareness campaign called FAST, which stands for: Face drooping, Arm weakness, Speech difficulty, Time to call 911.

“I fully support the FAST campaign,” says Cleveland Clinic neurologist and stroke specialist Efrain D. Salgado, MD. “This is an effort to help people remember the most commonly recognizable signs of stroke in order to speed 911 activation. There are a few other stroke symptoms and signs people should also know, but believe me, if these are the only ones they remember and equate these with 911 activation, this would be a huge victory.”

What is a stroke?
A stroke is the death of brain cells caused by a sudden lack of blood flow to the brain. It can be caused by a blockage in an artery supplying blood to the brain (ischemic stroke) or the rupture of a blood vessel in the brain (hemorrhagic stroke). The location of the stroke determines the severity of the event and the part of the body or body function that is most directly affected.

For example, the nerves controlling muscles on one side of the face are often damaged by a stroke, making it look like one side of the face is drooping. The same is true for weakness in the arm. In fact, a distinct change on one side of the body is a red flag for stroke.

An easy test, if someone is experiencing arm weakness or numbness is to have that person raise both arms to the side and see if one starts to drift downward.

Speech is also a very common function to be harmed by a stroke. A stroke victim may have trouble pronouncing words or understanding words spoken to him. If someone appears to be experiencing stroke symptoms, have him repeat the sentence, “The sky is blue.” If the words don’t come out right, call 911.

Temporary Symptoms
In some cases, these symptoms will only last for a matter of minutes, or even hours, and then you’ll feel fine. This may be the result of a transient ischemic attack (TIA), which is a temporary disruption of blood flow to the brain. And while a TIA may not cause lasting damage, it is an event that must be taken seriously, as about one in 10 people who have a TIA go on to have a full stroke. About half of those people have a stroke within a couple of days of the TIA, which means even if the stroke symptoms pass, you should still be evaluated by a doctor.

“If these symptoms are just fleeting, as with a TIA, it is just as important, if not more important, for people to be aware of the need to be taken to the ER immediately since this means that they are at high risk of a stroke, particularly over the first 48 hours,” Dr. Salgado says. “Speedy evaluation and treatment has the potential to avert the impending stroke. Most TIAs last no more than 10 to 15 minutes, but I would not wait to call 911. Even if symptoms resolve by the time 911 gets there, they should still transport the patient to the ER where they can start the necessary quick evaluation and treatment.”

Other Signs of Stroke
Though the face drooping, arm weakness and speech difficulties are the most common and obvious stroke symptoms, there are other signs worth knowing. For example, sudden vision changes can be brought on by a stroke. And a sudden, severe headache that is different from how you normally experience headaches can signal a stroke.

Difficulty with balance and walking is another common stroke symptom. Dr. Salgado notes that while some stroke symptoms can come on suddenly, other symptoms can grow gradually worse. For example, you may start noticing a mild tingling sensation in one arm that gets more intense over time. If you notice one stroke symptom, try going through the other tests to see if they may confirm what’s happening. In other words, look at yourself in the mirror and smile to see if your muscles respond appropriately. Speak to someone else to make sure your words sound right, and check your vision and balance.

And if you’re unsure, err on the side of caution and call 911. This is especially true for people who are at high risk for stroke, such as those with high blood pressure, heart disease and, of course a health history that includes a previous stroke.