Stroke Symptoms

What is a Stroke?

A stroke (cerebrovascular accident) occurs when blood flow to a region of the brain is suddenly interrupted, either by arterial occlusion (ischemic stroke — approximately 85% of cases) or by rupture of a blood vessel (hemorrhagic stroke — approximately 15% of cases). Deprivation of oxygen and glucose leads to neuronal death; it is estimated that approximately 1.9 million neurons die per minute during an untreated ischemic stroke.

"Time is brain" — early reperfusion therapy with intravenous thrombolysis (tPA) within 4.5 hours and mechanical thrombectomy within 24 hours in selected patients significantly improves functional outcomes.

Powers WJ, et al. 2019 AHA/ASA Guidelines for the Early Management of Patients with Acute Ischemic Stroke. Stroke. 2019;50(12):e344–e418. doi:10.1161/STR.0000000000000211

The BE-FAST Acronym (Updated from FAST)

Recent evidence supports the expanded BE-FAST acronym to identify additional stroke symptoms often missed by FAST alone:

  • B — Balance: sudden difficulty with balance or coordination
  • E — Eyes: sudden vision change, double vision, or loss of vision
  • F — Face: facial drooping (ask patient to smile)
  • A — Arms: arm or leg weakness (ask patient to raise both arms)
  • S — Speech: slurred, confused, or no speech
  • T — Time: time to call emergency services immediately

Transient Ischemic Attack (TIA)

Stroke symptoms that resolve completely within 24 hours (and typically within 1 hour) may represent a Transient Ischemic Attack (TIA). TIA is NOT benign — it carries a high short-term risk of completed stroke (up to 10–15% within 90 days, with highest risk in the first 48 hours). All TIA patients require urgent evaluation and secondary prevention.

Johnston SC, et al. Transient ischemic attack: part 1. Diagnosis and evaluation. N Engl J Med. 2002;347(21):1714–1721. doi:10.1056/NEJMcp020190

Treatment

  • IV alteplase (tPA): eligible patients within 4.5 hours of symptom onset
  • Mechanical thrombectomy: eligible patients within 6–24 hours depending on imaging criteria
  • Blood pressure management per guidelines
  • Antiplatelet therapy (aspirin / dual antiplatelet in TIA)
  • Anticoagulation (in cardioembolic stroke/AF)
  • Stroke unit admission
  • Rehabilitation: physiotherapy, speech therapy, occupational therapy

🔴 RED FLAGS — Seek Emergency Care Immediately

• Any sudden onset of BE-FAST symptoms — call emergency services immediately

• Sudden severe headache (thunderclap) — may indicate subarachnoid hemorrhage

• Sudden loss of vision in one eye (amaurosis fugax)

• Stroke symptoms that resolve — still requires emergency evaluation (TIA risk)
Keywords