
Strokes are a leading cause of death and disability in the US, with someone suffering a stroke every 40 seconds. However, up to 80% of strokes can be prevented, and knowing what to watch out for can save a life. If you think someone is suffering a stroke, you can test them using the F.A.S.T. test. This involves asking the person to smile, raise their arms, and repeat a simple phrase. If they display weakness or numbness in the face, or if one arm drifts downward, or if their speech sounds strange, you should call 911 immediately.
Characteristics | Values |
---|---|
Face | Ask the person to smile and check if one side of the face droops or is numb |
Arms | Ask the person to raise both arms and check if one arm drifts downward |
Speech | Ask the person to repeat a simple phrase and check if their speech sounds strange or slurred |
Time | Call emergency services immediately if the person shows any of the above symptoms |
Physical exam | Check blood pressure, alertness, numbness, weakness, vision, and coordination |
Neurological exam | Ask questions, test reflexes, and ask the person to perform simple actions |
Imaging tests | CT, MRI, CT or MR angiogram, carotid ultrasound, TCD ultrasound, EEG, ECG/EKG |
Blood tests | CBC, serum electrolytes, blood clotting tests, heart attack tests, thyroid tests, blood glucose, cholesterol tests, C-reactive protein test, blood protein test |
What You'll Learn
- The F-A-S-T test: check for face drooping, arm weakness, speech difficulties, and call 911
- CT scans: X-rays to check for brain bleeding/damage
- MRI scans: uses magnets/radio waves to create detailed brain images
- Carotid ultrasound: checks for fatty deposits blocking blood flow to the brain
- Blood tests: check red blood cell/platelet count, glucose levels, and clotting
The F-A-S-T test: check for face drooping, arm weakness, speech difficulties, and call 911
The F-A-S-T test is an easy-to-remember acronym that can help you identify the signs of a stroke and act quickly. Here's what it stands for:
F is for Face Drooping: Check if one side of the person's face is drooping or numb. Ask them to smile and observe if their smile is uneven.
A is for Arm Weakness: Check if one arm is weak or numb. Ask the person to raise both arms and observe if one arm drifts downward.
S is for Speech Difficulties: Listen for slurred speech or difficulty in understanding or producing speech. Ask them to repeat a simple sentence like "The sky is blue" to check their comprehension and speech.
T is for Time to call 911: If you observe any of the above signs, it's crucial to act fast. Call 911 immediately and note the time when the symptoms first appeared. Stroke is a medical emergency, and early treatment improves survival rates and lowers disability risks.
Remember, stroke symptoms can vary, and other signs may include numbness or weakness in the face, arm, or leg, confusion, trouble seeing, walking, or maintaining balance, and a severe headache. If you or someone you know is experiencing any of these symptoms, don't delay—call 911 right away.
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CT scans: X-rays to check for brain bleeding/damage
If you suspect that you or someone else is having a stroke, it is important to call 911 or go to the nearest emergency room. Tests for stroke usually start in the ambulance, before reaching the hospital. This is why it is important to call 911 rather than going to the hospital by car.
One of the tests used to diagnose a stroke is a CT scan. This is a non-invasive diagnostic imaging procedure that uses X-rays to produce horizontal, or axial, images (often called slices) of the brain. The X-ray beam moves in a circle around the body, allowing many different views of the brain. The X-ray data is sent to a computer that interprets the data and displays it in a two-dimensional form on a monitor.
CT scans can be done with or without "contrast." Contrast refers to a substance taken by mouth or injected into an intravenous (IV) line that causes the particular organ or tissue under study to be seen more clearly.
CT scans can show bleeding in the brain or damage to brain cells. They can also find other problems that may be causing stroke symptoms. CT scans are usually one of the first tests used for a stroke.
If you are having a CT scan, you may be asked to change into a patient gown and remove all piercings and jewellery. You will lie on a scan table that slides into a large, circular opening of the scanning machine. The technologist will be in another room where the scanner controls are located, but you will be in constant sight of the technologist through a window. Speakers inside the scanner will enable two-way communication between you and the technologist.
As the scanner begins to rotate around you, X-rays will pass through your body for short amounts of time. You will hear clicking sounds, which are normal. You must remain very still during the procedure. You may be asked to hold your breath at various times during the procedure.
If contrast media is used for your procedure, you may feel some effects when the media is injected into the IV line. These effects include a flushing sensation, a salty or metallic taste in your mouth, a brief headache, or nausea and/or vomiting. These effects usually last for a few moments.
You should notify the technologist if you experience any breathing difficulties, sweating, numbness, or heart palpitations.
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MRI scans: uses magnets/radio waves to create detailed brain images
If you suspect that you or someone you are with is having a stroke, it is important to call an ambulance immediately. Stroke is a medical emergency, and tests usually begin in the ambulance before reaching the hospital. While in the ambulance, an ambulance worker will start a stroke exam, which a doctor will continue at the hospital. This will involve asking about symptoms and medical history, as well as doing a physical exam to check for factors such as blood pressure, mental alertness, numbness, weakness, or trouble speaking, seeing, or walking.
At the hospital, doctors will use imaging tests to see inside the brain and determine the type of stroke and the extent of the damage. One such imaging test is a Magnetic Resonance Imaging (MRI) scan. MRI scans use a strong magnet and radio waves to create highly detailed images of the brain. They are more accurate than other imaging techniques, such as computed tomography (CT) scans, as they are more sensitive and can detect even tiny abnormalities. MRI scans can also show brain changes caused by a stroke sooner than a CT scan and can rule out other problems, such as tumours, that may be causing stroke-like symptoms.
While MRI scans provide more detailed images, they do have some drawbacks. They take longer than CT scans and are not as readily available. They are also not suitable for people with metallic or electronic implants, such as pacemakers, or shrapnel wounds. Additionally, people with claustrophobia may find the longer duration of an MRI scan uncomfortable.
Overall, MRI scans are a valuable tool in the diagnosis and treatment of strokes, providing detailed images that can help doctors identify the type of stroke and determine the best course of treatment.
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Carotid ultrasound: checks for fatty deposits blocking blood flow to the brain
Carotid ultrasound is a test that uses sound waves to create images of your carotid arteries, which are the main suppliers of blood to your brain. It is a painless, safe, and non-invasive procedure that can be done in your healthcare provider's office or a healthcare facility. During the test, you will lie on your back while the healthcare provider applies a clear gel to the sides of your neck and presses a transducer (a small, handheld device) against your skin. The gel and transducer work together to help the ultrasound device capture clear images of your carotid arteries. The sound waves emitted by the transducer bounce off your arteries and create images on a monitor, allowing the healthcare provider to see if there is any narrowing or blockage.
The carotid ultrasound can detect plaque buildup, which is a mixture of fat, cholesterol, and other substances that can accumulate on the walls of your carotid arteries. This buildup can restrict and eventually block blood flow to your brain, face, and neck. A blocked carotid artery is a serious issue as it can lead to a stroke. Therefore, the carotid ultrasound is an important tool for stroke prevention. If your healthcare provider finds that your arteries are partially blocked, they may recommend lifestyle changes, such as improving your diet and exercising more. In cases of severe blockage, they may prescribe medication or even recommend surgery to remove the plaque.
You may need a carotid ultrasound if you have had surgery on a narrowed artery, have high blood pressure or high cholesterol, have a family history of stroke or heart disease, or exhibit other risk factors. The test typically takes 30 to 45 minutes, and you can resume your normal activities immediately afterward. There are no risks or pain associated with the procedure, and it is an effective way to detect any issues with your carotid arteries early on.
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Blood tests: check red blood cell/platelet count, glucose levels, and clotting
While blood tests are not a substitute for immediate medical attention, they can help diagnose a stroke and determine its type and cause. Blood tests can also be used to monitor a patient's condition and adjust their treatment accordingly. Here are some of the blood tests that may be relevant in the context of a stroke:
Red Blood Cell Count
A full blood count is a routine blood test that can count the number of red blood cells, white blood cells, and platelets per millilitre of blood. This test will detect low levels of platelets, which can be indicative of a bleeding disorder or certain liver diseases.
Platelet Count
A platelet count (PLT) measures the number of platelets in your blood. Platelets are cell fragments that form clots when there is damage to a blood vessel. They play a crucial role in stopping bleeding. A normal platelet count range is between 150,000 and 400,000 platelets per microlitre of blood. A count below 150,000 is considered low (thrombocytopenia), while a count above 450,000 is considered high (thrombocytosis). Having too many platelets can increase the risk of blood clots and stroke.
Blood Glucose Level
A blood glucose test measures the level of glucose (sugar) in the blood and is primarily used to screen for diabetes. High blood glucose levels, known as hyperglycemia, are indicative of diabetes. This can be further confirmed by a glycated haemoglobin test (A1C), which shows the average blood sugar level over a few months.
Blood Clotting Tests
These tests are used to diagnose and assess bleeding problems and monitor people taking anticoagulant medications. There are several types of blood clotting tests, including the prothrombin time (PT) and activated partial thromboplastin time (APTT) tests, which measure the time it takes for a blood clot to form after the addition of activating chemicals. These tests can help identify which clotting factors are low or absent.
It is important to note that while these blood tests can provide valuable information, diagnosing a stroke typically requires a comprehensive approach involving additional tests and examinations, such as CT, MRI, and ultrasound scans, as well as an electrocardiogram (ECG) to check the heart.
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Frequently asked questions
The F-A-S-T test is a simple way to check for the most common warning signs of a stroke. Ask the person to:
Arms: Raise both arms. Does one arm drift downward? Can they lift one arm higher than the other? That signals weakness on one side of the body.
Time: If the person failed any part of the test, note the time and get help. Call emergency services immediately. Let them know what time you gave this test so they can estimate the length of the stroke.
If any of the following symptoms happen suddenly, you might be witnessing a stroke:
- Weakness or numbness in the face, arm or leg, usually on just one side
- Difficulty speaking or understanding language
- Decreased or blurred vision in one or both eyes
- Unexplained loss of balance or dizziness
- Severe headache with no known cause
A stroke is a medical emergency. The stroke victim needs treatment right away. Call emergency services and get the person to the nearest ER as soon as possible.