A stroke occurs when blood flow to a section of the brain is interrupted, either by a blockage (ischemic stroke) or the rupture of a blood vessel (hemorrhagic stroke). When the brain is deprived of oxygen and nutrients, brain cells begin to die within minutes. Immediate recognition and response are urgent for saving brain function and mitigating lasting disability.
Rapid Assessment: Face, Arms, and Speech
The three questions to ask a person suspected of having a stroke are tied to a simple, effective screening tool used by bystanders and emergency responders. This quick assessment focuses on recognizing the most common physical signs of a stroke, which affect movement and communication. These signs are gauged by performing three simple tests of neurological function.
The first test checks for facial weakness by asking the person to smile. Unilateral facial drooping, where one side of the mouth or eye appears lower, is a positive sign. Next, assess arm strength by asking the person to raise both arms straight out and hold them for about ten seconds. If one arm drifts downward involuntarily or cannot be lifted, this indicates weakness or numbness.
The third test evaluates speech by asking the person to repeat a simple phrase, such as “The sky is blue.” Listen for slurred words, difficulty forming the sentence, or garbled speech. If the person shows difficulty with any of the face, arm, or speech tests, a stroke is likely, and emergency medical services must be contacted immediately.
Recognizing Other Acute Stroke Symptoms
While the three-part assessment covers the most frequent indicators, a stroke can present with other sudden symptoms not always part of the core screening. These additional signs relate to areas of the brain controlling balance, coordination, and sensation. Look for a sudden loss of balance or coordination, which may manifest as severe dizziness or an inability to walk normally.
Sudden vision problems, such as double vision or abrupt loss of sight in one eye, can also signal a stroke. A sudden, severe headache is a concerning symptom, particularly with a hemorrhagic stroke. If these secondary indicators appear suddenly, they require the same urgent medical response.
Why Time is the Most Critical Factor
If any rapid assessment tests or other symptoms are positive, the immediate next step is to call for emergency help. The medical concept of “time is brain” underscores the urgency, as an average of 1.9 million neurons are lost every minute a stroke goes untreated. This rapid loss of brain tissue means every moment counts in preserving function and improving recovery chances.
When contacting emergency services, note the exact time the symptoms first appeared, referred to as the “Last Known Well” time. This precise time stamp determines a patient’s eligibility for time-sensitive treatments, such as clot-busting drugs like tissue plasminogen activator (tPA). This medication must be administered within a few hours of symptom onset to be effective.
While waiting for help, keep the person calm and comfortable, and avoid giving them anything to eat or drink. Relay the assessment results and the Last Known Well time to the emergency operator or incoming medical personnel. This preparation ensures that paramedics can begin life-saving treatments immediately, often en route to a specialized stroke center.