Spotting Stroke Symptoms: Can It Be Done?

A stroke is a life-threatening condition that occurs when there is an interruption in blood flow to the brain, resulting in brain cells being deprived of oxygen and dying. It is crucial to recognise the signs of a stroke and act quickly to prevent permanent damage or death. The FAST test is a simple way to identify the most common symptoms: Face Drooping, Arm Weakness, Speech Difficulty, and Time to call emergency services. Other signs include sudden numbness, confusion, vision problems, dizziness, severe headache, andsection of the BE FAST test, balance issues, and double vision. Immediate medical attention is critical, and certain treatments are only available within the first few hours of the onset of symptoms.

Face drooping

Facial drooping, or palsy, is a common symptom of a stroke. It occurs when the facial muscles are not working properly, causing the eyelids, cheeks, or corners of the mouth to droop on one or both sides of the face. This may result in an involuntary smile or difficulty smiling voluntarily.

Facial drooping is a serious condition that requires immediate medical attention. If you or someone you know is experiencing this symptom, it is important to call emergency services right away. Quick treatment is crucial to prevent permanent damage or even death. While waiting for emergency services to arrive, you can administer first aid by ensuring the person's safety, noting the time symptoms began, and keeping them warm if they are cold.

To identify a stroke, remember the acronym F.A.S.T:

• Face Drooping – Check for drooping or numbness on one side of the face. Ask the person to smile and observe if their smile is uneven.
• Arm Weakness – Check if one arm is weak or numb by asking the person to raise both arms. Look for one arm drifting downward.
• Speech Difficulty – Listen for slurred speech or difficulty speaking clearly.
• Time to call emergency services – Stroke is an emergency, and every minute counts. Call 911 immediately and note the time when the symptoms first appeared.

In addition to facial drooping, other signs of a stroke include:

• Numbness or weakness on one side of the body
• Sudden confusion or difficulty understanding speech
• Vision problems in one or both eyes
• Dizziness, loss of balance, or coordination issues
• Severe headache with no known cause
• Memory problems, disorientation, or confusion
• Nausea or vomiting

Arm weakness

Isolated hand palsy or fractional arm weakness is a rare presentation of a stroke, often mistaken for a peripheral lesion. In these cases, the weakness of the hand differs from that of the shoulder. This type of arm weakness is caused by embolic stroke involving the hand knob area, large artery atherosclerotic infarct of vascular borderzones, and small subcortical lacunar infarct. It can also be caused by inferior parietal lobe infarctions due to severe carotid stenosis or dissection.

If someone is displaying signs of arm weakness, it is important to act quickly. Call emergency services immediately, as strokes are a life-threatening condition and require immediate medical attention to prevent permanent damage or death. The quicker a stroke is treated, the more likely the person will recover without disability.

Speech difficulties

There are several types of aphasia:

• Broca's aphasia (expressive aphasia): difficulty with spoken and written expression.
• Anomic aphasia: difficulty with word retrieval, demonstrated by slow and halting speech.
• Wernicke's aphasia (receptive aphasia or fluent aphasia): difficulty understanding speech and producing meaningful speech; the person affected may speak in long, fluent sentences that don't make sense.
• Conduction aphasia: difficulty with repeating words or phrases.
• Global aphasia: difficulties with both speech production and comprehension.

Dysarthria is another condition that can occur after a stroke, where the muscles in the face, mouth and throat are difficult to control, leading to slurred or slow speech.

Apraxia of speech is a third condition that can occur, where the muscles in the face, mouth and throat cannot be moved in the correct order when speaking, making it hard for others to understand the speaker.

To recover from a stroke affecting speech, individuals can work with a speech-language pathologist or speech therapist, who will evaluate their speech, language and communication skills, and develop a treatment plan. Treatment may include tongue and lip exercises, naming therapy, and singing therapy.

Time to call emergency services

Time is critical when responding to a stroke. If you suspect that you or someone else is having a stroke, act quickly and call 911 or your local emergency services immediately. Do not drive yourself to the hospital and don't ask someone else to drive you. Call for an ambulance so that medical personnel can begin administering treatment while en route to the hospital.

The quicker a person having a stroke receives medical care, the more likely the effects of the stroke will be limited or reversible. On average, 1.9 million brain cells die every minute a stroke goes untreated. Therefore, early treatment leads to higher survival rates and lower disability rates.

If you are concerned about calling 911 as a bystander, you can stay anonymous. You do not have to provide your name, telephone number, or other identifying information. If you do not speak English, simply dial 911 and say: "Stroke. Spanish interpreter," or ask for whatever language you feel comfortable speaking. Most EMS dispatch centers can respond to calls in Spanish and other languages.

When you call 911, the operator may ask a few questions to dispatch the right emergency responders as quickly as possible. Be prepared to provide the following information:

• Address or location if you are in a public place
• That you suspect a stroke and what symptoms you are observing
• When the person started experiencing stroke symptoms
• The person's name, age, and description
• Whether the person is conscious or breathing

The operator may also ask for information about yourself, such as your name and phone number.

Balance and vision issues

Vision Issues after Stroke

About 60-65% of stroke survivors experience vision problems. The type of vision problem depends on the location of the stroke in the brain. Strokes can affect the occipital lobe, which is responsible for processing visual inputs, and the brainstem, which controls eye movements, balance, and interpreting objects. As a result, common visual symptoms of stroke include:

• Loss of vision in one or both eyes, or in parts of the visual field (hemianopia, quadrantanopia, scotoma)
• Double vision (diplopia)
• Blurred vision
• Light sensitivity
• Dry eyes
• Visual hallucinations
• Difficulty judging depth and movement
• Visual neglect or spatial inattention, where individuals are not aware of or do not respond to things on their affected side
• Agnosia, a rare disorder where individuals cannot retrieve visual information from memory

Balance Issues after Stroke

Balance issues are also common after a stroke, often occurring alongside vision problems. This is because balance relies on input from the visual system, as well as the vestibular system in the inner ear and sensory information from the body. When the brain is damaged by a stroke, it can affect the integration of these inputs, leading to balance disorders.

Management and Treatment of Vision and Balance Issues

The management and treatment of vision and balance issues after a stroke involve a multidisciplinary team of healthcare professionals, including eye doctors, brain doctors, and specialists in neuro-ophthalmology and neuro-optometry. Rehabilitation and training programs are often used to help individuals adjust to their vision loss and improve their balance. These programs may include:

• Scanning techniques to train the eyes to navigate towards and away from areas of vision loss
• Prisms added to glasses to change how objects are perceived
• Relaxation and breathing techniques
• Balance and spatial awareness activities
• Computer-based rehabilitation programs to improve scanning abilities
• Glasses, corrective contact lenses, and patching to address specific issues
• Over-the-counter eye drops, sunglasses, and anti-glare glasses to address dry eyes and light sensitivity

While some individuals may experience improvements in their vision and balance with early and intensive rehabilitation, for many, the effects of stroke on vision and balance can be permanent. Therefore, it is crucial to seek immediate medical attention if any symptoms of stroke are present, as timely treatment can improve outcomes and reduce the risk of permanent damage or death.

Frequently asked questions