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Life Guide U.S. essentials
English

If there is sudden spinning dizziness with unsteadiness, double vision, blackout in one eye, or the fingertip can't reach your own nose, treat it as a stroke and call 120 (China's ambulance number)

  • Top value
  • Evidence B
  • Buys life
  • Free
  • Takes minutes
  • No willpower

In a real emergency, call 911 first, then read this.

In plain words

If you look only at the three signs of face, arms and speech, more than one in ten strokes will be missed, because some strokes start with neither a drooping mouth nor a weak hand. If unsteadiness, double vision and a missing patch in the vision are counted too, the share missed falls to 4.4%. Sudden spinning dizziness with inability to stand, double vision, or being unable to touch your fingertip to your nose are also reasons to call 120 and note the time.

Cost

Free. Add two more checks to the three actions of "face, arms, speech" (§13.3, mouth suddenly drooping or speech slurred). One is to have the person stand straight with eyes closed and see whether they sway, then ask whether they see double or have a missing patch in their vision. The other, if you suspect a stroke, is to reach out and touch your fingertip to your nose, then close your eyes and do it again.

What you get

In 2014, the stroke center at the University of Kentucky in the United States reviewed the records of 736 acute ischemic strokes (stroke caused by a blocked vessel). Of these patients, 14.1% had none of the three symptoms of facial droop, arm weakness and unclear speech (FAST) at onset. When "unsteady walking, leg weakness and visual symptoms" were also counted in the screening, the share missed fell from 14.1% to 4.4%

Notes

When the vessels in the cerebellum and brainstem area are blocked (posterior circulation infarction), the mouth often doesn't droop and the hand isn't paralyzed. There may only be spinning dizziness, a staggering walk, diplopia (double vision) and choking on drink or food, which are most easily taken for a neck problem, low blood sugar or inner-ear stones and so delayed. Missing the nose with the finger and being unable to stand with eyes closed are signs that the cerebellum is affected. But no single check can rule out a stroke: if the symptoms come on suddenly and do not ease, call 120 and note the exact time they began. The study looked only at the records of one hospital, and the authors themselves say it needs to be verified again

Evidence grade
B : Supported by research but without a precise number, or based on small or single studies.
Sources
  1. Aroor S, Singh R, Goldstein LB (2017). BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic. Stroke, 48(2), 479-481. https://doi.org/10.1161/STROKEAHA.116.015169

Translated from the Chinese original. Original book, section 13, tip 4. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer