Signs & Symptoms of a Stroke - BEFAST

A stroke occurs when the blood supply to your brain is interrupted or reduced, which deprives your brain of oxygen and nutrients – causing your brain cells to die. You may also hear strokes called “brain attacks” because of how quickly and tragically they affect the brain. Stroke symptoms that are transient, typically lasting only minutes and leaving no permanent brain damage, are called a transient ischemic attack or TIA. In the case of either stroke or TIA,  patients need to seek immediate medical attention to assure appropriate treatment to minimize permanent brain damage.

The evolution of stroke signs and symptoms assessment led to the transition from FAST and FASTER to the more comprehensive acronym BEFAST. We recommend including more information on the FAST and FASTER acronyms and how they were developed and changed over time. Explain how BEFAST is an updated version of the original FAST acronym, which incorporates additional crucial indicators to enhance stroke recognition and response.

Provide more details on the different letters of the BEFAST method, going into detail about what the different symptoms will feel like and how someone can differentiate them from symptoms of another disease.

While the original FAST (Face, Arms, Speech, Time) acronym focuses on the common signs of stroke, BEFAST adds two additional important indicators to improve stroke identification:

• Balance
• Eyes

By incorporating these additional indicators, BEFAST increases the likelihood of recognizing a stroke, especially in cases where the classic symptoms may not be as prominent.

• Balance: Sudden loss of balance or coordination can be a symptom of a stroke. Individuals may experience dizziness, difficulty walking, stumbling, or a sense of unsteadiness. It's important to note that balance issues can also be caused by other conditions, such as inner ear problems or musculoskeletal issues. However, if the loss of balance is sudden and not attributed to any obvious cause, it should be taken seriously and medical attention should be sought.
• Eyes: Changes in vision or sudden loss of vision in one or both eyes can be indicative of a stroke. This can manifest as blurred vision, double vision, partial or total loss of vision, or difficulty seeing in one eye. Vision problems can also be related to other eye conditions or injuries. However, sudden and unexplained changes in vision should be considered a medical emergency and require immediate evaluation.
• Face: Facial drooping or asymmetry can be a classic sign of a stroke. One side of the face may appear droopy or numb, and the person may have difficulty smiling or closing their eyes symmetrically. It is essential to differentiate this from temporary facial weakness or muscle spasms that may have other causes.
• Arms: Weakness or numbness in one or both arms, particularly on one side of the body, can indicate a stroke. The individual may have difficulty raising both arms or experience a loss of coordination in arm movements. It is important to distinguish this from temporary muscle weakness due to fatigue or musculoskeletal issues.
• Speech: Speech difficulties are common in stroke cases. Individuals may experience slurred speech, difficulty finding the right words, or being unable to speak at all. It's important to note that speech difficulties can also occur in other conditions, such as certain neurological disorders or medication side effects. However, sudden and unexplained changes in speech should not be ignored.
• Time: Time is of the essence because certain treatment options, such as clot-dissolving medications or endovascular procedures, are most effective when administered within a specific time window after the onset of stroke symptoms. This serves as a reminder to call emergency services or seek medical help without delay. It emphasizes the importance of not hesitating or waiting to see if the symptoms will improve on their own.

Other symptoms of stroke could include:

• Numbness and weakness typically on one side of the body: This symptom often occurs in stroke, where individuals may experience sudden loss of sensation or weakness in one side of the body. It can affect the face, arm, or leg on one side, making it difficult to move or control those body parts.
• Confusion: Confusion can be a less common but significant symptom of stroke. It may manifest as difficulty understanding, processing information, or expressing oneself. Sudden confusion, disorientation, or an inability to think clearly should be evaluated promptly.
• Visual disturbances: Stroke can cause various visual changes, including blurred vision, double vision, partial loss of vision, or even temporary blindness in one or both eyes. These visual disturbances may arise suddenly and should be taken seriously, especially when combined with other stroke symptoms.
• Dizziness and poor balance: Some individuals experiencing a stroke may feel dizzy or have difficulties with balance and coordination. This can lead to unsteadiness while walking, a spinning sensation (vertigo), or a feeling of being lightheaded. Sudden and severe dizziness should be assessed, particularly if accompanied by other stroke symptoms.
• Rapid onset severe headache: While headaches are not always associated with stroke, a sudden and severe headache can indicate a type of stroke known as a subarachnoid hemorrhage. This type of headache is often described as the worst headache of one's life and requires immediate medical attention.

Because swift care is vital for improving outcomes after a stroke, seek immediate care in the ER or call 911 if a loved one displays any symptoms of a stroke.

Learn more about the different stroke types

Stroke symptoms in women vs men

Stroke signs in women:

• Sudden weakness or numbness
• Generalized weakness, fatigue, or malaise
• Sudden face and limb pain
• Shortness of breath
• Hiccups
• Nausea
• Chest pain
• Palpitations

Women may have more subtle or atypical stroke symptoms that can be easily overlooked or misinterpreted. Additionally, women are more prone to certain types of strokes, such as those associated with hormonal changes during pregnancy or the use of oral contraceptives

Stroke signs in men:

• Sudden weakness or numbness on one side of the body, particularly in the face, arm, or leg
• Difficulty speaking or slurred speech
• Sudden confusion or disorientation
• Problems with coordination and balance.

Men may be more likely to present with more noticeable physical symptoms during a stroke.

Silent stroke or pre-stroke?

A "silent stroke," also known as a silent cerebral infarction, is a type of stroke that does not present with immediate or obvious symptoms. Unlike a typical stroke, where symptoms such as weakness, speech difficulties, or vision changes are noticeable, a silent stroke occurs when a small blood vessel in the brain becomes blocked or restricted, resulting in damage to brain tissue without immediate symptoms.

Silent strokes often go unnoticed because they do not cause the usual visible signs associated with stroke. However, even though the symptoms are not apparent, these silent strokes can still have significant effects on a person's body. 

The damage caused by silent strokes can accumulate over time and affect cognitive functions, such as memory, attention, and problem-solving abilities. They can also contribute to the development of vascular dementia or increase the risk of subsequent strokes.

Although silent strokes may not be immediately recognized, they can be detected through imaging tests, such as MRI scans, which can reveal the presence of small areas of brain tissue damage.

The risk factors for silent strokes are similar to those for symptomatic strokes and include high blood pressure, diabetes, smoking, high cholesterol, and atrial fibrillation. Additionally, individuals who have had silent strokes may have a higher risk of future strokes, making proper management of risk factors and regular medical monitoring essential.

Who is at risk for stroke?

The American Heart Association/American Stroke Association reports that stroke is the fifth leading cause of death and the leading cause of adult disability in the United States. On average, someone in the US suffers a stroke every 40 seconds and nearly 795,000 people suffer a new or recurrent stroke each year.   

There are some risk factors out of a person’s control – including age, family history of heart disease or strokes, and gender. Women are more likely than men to suffer a stroke and often do so later in life. African Americans are at a much higher risk of dying from stroke, likely due to a greater prevalence of diabetes, high blood pressure and obesity.

If you’ve had a previous stroke or heart attack, your risk of a second stroke increases. Individuals who have experienced a transient ischemic attack (TIA), often called a mini stroke, are almost 10 times more likely to have a stroke than someone of the same sex and age who have not experienced these symptoms. Approximately 15% of patients who experience a transient ischemic attack, will suffer a stroke within the next 90 days.. 

Although a stroke often seems unexpected, there are key risk factors that make a stroke more likely. The following risk factors for stroke can be modified, treated or managed medically. 

 

Smoking

Smoking makes an individual four times more likely to die of heart attack or stroke. It damages the blood vessels leading to your heart, and even secondhand smoke makes those around you 30% more likely to suffer from heart disease. Cutting back on the amount of nicotine you consume can improve your blood circulation and reduce the health risks associated with the habit. Better yet, quitting altogether gives your heart and blood vessels an opportunity to repair themselves! If you’re ready to quit, learn more about CHI Memorial’s smoking cessation class.  

 

High blood pressure and cholesterol

Hypertension, commonly known as high blood pressure, is a major risk factor for heart disease and stroke. The American Heart Association recommends your blood pressure be less than 130/80. Why does your blood pressure matter? High blood pressure gradually increases the pressure of blood flowing through all the arteries in your body, damaging or narrowing your arteries and ultimately limiting blood flow. Uncontrolled hypertension weakens your brain’s blood vessels, causing them to rupture or leak. This is commonly known as a stroke. 

Individuals with a total cholesterol level of 240 mg/dL or higher are at increased risk of heart disease and stroke. Uncontrolled cholesterol levels can lead to the development of fatty deposits in the blood vessels, which can make it difficult for blood to freely flow through the arteries. If these deposits break off suddenly, they can form a clot that causes a heart attack or stroke. 

 

Heart disease

The link between heart disease and stroke is significant. Individuals with coronary heart disease, angina or who have had a heart attack due to atherosclerosis are at two times the risk of having a stroke. Several other types of heart disease including atrial fibrillation, heart failure, heart valve disease and some congenital heart defects can also increase a person’s risk. Many of these health conditions are related, and it’s important for you to work closely with your healthcare provider to address and manage these individual risks.

 

Vascular disease

Individuals with carotid artery disease, peripheral artery disease or other conditions caused by atherosclerosis, or the hardening and narrowing of the arteries, are at an increased risk of stroke. This narrowing is due to a buildup of plaque on the artery walls, causing a decrease in blood flow. Like other conditions that cause hardening and narrowing of the arteries, treatment options for carotid artery stenosis include surgery, blood thinning medications, medicine and diet changes to lower your cholesterol and blood pressure and routine screening by your medical team. 

 

Diabetes

Diabetes is an independent risk factor for stroke that affects more than 30 million Americans. This condition results from too much sugar in the blood and is usually related to being overweight. When you have type 2 diabetes, the most common form of diabetes, your body does not use insulin properly. This is called insulin resistance. One of the most difficult aspects of diabetes control tends to be compliance with medications and a general misunderstanding of how diet choices are leading to uncontrolled diabetes. In addition to increased stroke risk, diabetes can result in unpleasant symptoms and severe complications for your heart and blood vessels, kidneys, nerves, GI tract, and your eyes.

 

Diet

What you eat has an impact on your overall stroke risk. Diets high in saturated and trans fats can raise blood cholesterol levels, and high amounts of sodium can increase blood pressure. Trans fats are a type of artificial fat used to add a desirable texture and taste to processed foods, such as frozen pizzas, cookies and margarines. Although tastier, trans fat consumption leads to increased risk of heart disease, stroke, and clogged arteries.

By decreasing the amount of trans fat you consume, you are actively improving your body’s blood flow and lowering dietary risks to your heart’s health. Eating a healthy, balanced diet – including a variety of fruits, vegetables, protein, and starchy foods – can help you maintain a healthy weight, lower blood pressure, and cholesterol levels and keep diabetes under control. 

 

Why you should choose CHI Memorial

A stroke is always unexpected, but CHI Memorial is here to care for you. With a coordinated team of world-renowned vascular and interventional neurologists, neuro radiologists, certified stroke nurse practitioners, emergency physicians, telemedicine experts, experienced research coordinators and other stroke specialists working together, we quickly identify the symptoms of stroke and get you to the very best treatment FAST.

Learn more about or stroke care

 

Frequently asked questions

Can you have a stroke without knowing?

Yes, it is possible to have a stroke without knowing it. This is often referred to as a "silent stroke" or a silent cerebral infarction. Silent strokes occur when there is a disruption of blood flow to a part of the brain, resulting in brain tissue damage, but they do not cause immediate noticeable symptoms.

 

Are there warning signs days before a stroke?

In some cases, there may be warning signs or symptoms that occur in the days leading up to a stroke. These warning signs, often referred to as transient ischemic attacks (TIAs) or mini-strokes, are temporary disruptions of blood flow to the brain. TIAs can be considered as warning signs because they indicate an increased risk of a full-blown stroke in the near future.

The symptoms of a TIA are similar to those of a stroke but typically resolve within a short period, usually within minutes to hours. These symptoms may include sudden weakness or numbness on one side of the body, difficulty speaking or understanding speech, vision changes, dizziness, or severe headaches.

 

What are the first signs of a stroke coming on?

The first signs of a stroke can vary depending on the individual and the specific type of stroke. However, there are common warning signs that may indicate a stroke is occurring. It's important to remember the acronym "FAST" as a simple way to remember the signs:

• Face drooping: One side of the face may droop or feel numb. Ask the person to smile and check if their smile is uneven or lopsided.
• Arm weakness: One arm may become weak or numb. Ask the person to raise both arms and see if one arm drifts downward.
• Speech difficulty: Speech may be slurred or hard to understand. Ask the person to repeat a simple phrase and check for any abnormal speech patterns.
• Time to call emergency services: If you observe any of these signs, it's crucial to call emergency services immediately. Time is critical for stroke treatment, so do not delay.

Do stroke symptoms develop suddenly or gradually?

Stroke symptoms typically develop suddenly rather than gradually. The onset of stroke symptoms is often rapid and occurs within seconds or minutes. The sudden nature of stroke symptoms is one of the key distinguishing factors between a stroke and other medical conditions that may have more gradual or progressive symptom development.

Regardless of the speed at which symptoms appear, prompt medical attention is essential if stroke is suspected. If you or someone around you experiences any symptoms that may indicate a stroke, it is crucial to call emergency services immediately to seek immediate medical care. Timely intervention can greatly improve the chances of a positive outcome and reduce potential long-term disabilities associated with stroke.