Signs of Stroke: 3 ways to recognize early symptoms to administer first aid

Every year, stroke affects more than 12 million people worldwide, with approximately 6.5 million deaths and millions more living with long-term sequelae. The concerning issue is that many cases miss the "golden hour" simply because they don't recognize the signs of stroke from the very first minutes. Even a slight delay in taking the patient to the hospital significantly increases the risk of death or permanent disability.

In this article, Tiptory will help you recognize common signs of stroke early, understand when to call emergency services immediately, and know how to handle the situation correctly during the golden hour. Equipping yourself with this knowledge not only helps protect your own health but can also contribute to saving the lives of loved ones or those around you in an emergency.

Part 1: How to quickly recognize the signs of stroke

Method 1: Distinguishing between stroke and transient ischemic attack

Understanding the difference between stroke and transient ischemic attack

• What is a stroke?
  • Stroke occurs when blood flow to the brain is interrupted, causing brain cells to be deprived of oxygen and nutrients. If not treated promptly, brain cells can be permanently damaged in a short period.
  • This is a medical emergency, and the patient needs to be taken to the hospital as soon as possible to increase the chances of treatment and reduce the risk of death or disability.

Two common types of stroke

• Ischemic stroke
  • This is the most common type of stroke, occurring when a blood clot blocks an artery supplying blood to the brain.
  • Due to insufficient oxygen supply to the brain, brain cells begin to be damaged if blood flow is not restored in time.
• Hemorrhagic stroke
  • This type occurs when a blood vessel in the brain ruptures, causing blood to leak into the brain tissue and increase pressure on the brain.
  • Although less common than ischemic stroke, hemorrhagic stroke often progresses rapidly and carries a life-threatening risk if not treated urgently.

What is a transient ischemic attack (TIA)?

• Transient ischemic attack, also known as a mini-stroke or TIA, occurs when blood flow to the brain is temporarily reduced.
• Symptoms may last from a few minutes to less than 24 hours and then disappear on their own, leading many to mistakenly believe they are cured or to ignore the warning signs.

Do not be complacent with a mini-stroke

• Even if symptoms completely disappear, TIA is still a warning sign of the risk of a real stroke occurring shortly thereafter.
• If you or someone around you experiences signs of stroke such as facial drooping, arm weakness, speech difficulty, or loss of balance, even for a few minutes, take the patient to a medical facility immediately for examination and timely treatment. Early detection can help prevent a severe stroke in the future.

Method 2: Recognizing typical stroke symptoms

Observe two or more stroke symptoms

• Sudden numbness or weakness on one side of the body
  • The patient may experience numbness, muscle weakness, or loss of movement on one side of the face, one arm, or one leg.
  • This is one of the most common signs of stroke and often appears very quickly.

Sudden decrease or loss of vision

• The patient may experience blurred vision, double vision, or loss of vision in one or both eyes without a clear cause.
• Sudden changes in vision should be considered a serious warning sign, especially when accompanied by other neurological symptoms.

Difficulty walking, dizziness, or loss of balance

• The patient may suddenly feel dizzy, unsteady, lose coordination, or be unable to stand.
• If this condition appears suddenly and is not related to motion sickness, fatigue, or other clear causes, the risk of stroke should be considered.

Confusion, speech difficulty, or inability to understand speech

• The patient may have slurred speech, stuttering, unclear pronunciation, or be unable to express what they want to say.
• In some cases, the patient remains conscious but does not understand what others are saying or answers questions incorrectly.

Sudden severe headache

• The headache can be very severe, appearing suddenly and without a clear cause, especially if the patient has never experienced such a condition before.
• When a severe headache is accompanied by signs of stroke such as paralysis, speech disorder, or loss of balance, call emergency services and take the patient to the hospital immediately.

When to call emergency services immediately?

• If the patient exhibits two or more stroke symptoms, do not wait for the symptoms to disappear on their own.
• Call emergency services or take the patient to a medical facility capable of treating stroke as soon as possible. Intervention during the "golden hour" can significantly reduce the risk of death and long-term sequelae.

Method 3: Checking for stroke using the FAST rule

Applying the FAST rule to quickly recognize stroke

• F – Face
  • Ask the person suspected of having a stroke to smile or show their teeth.
  • Observe if one side of the face is drooping, crooked, or asymmetrical.
  • If the smile is noticeably uneven or the face shows signs of numbness or weakness, this could be a sign of stroke.

A – Arms

• Ask the patient to raise both arms to shoulder level simultaneously.
• If one arm cannot be lifted, is weak, or automatically falls while the other arm remains in position, the likelihood of stroke is very high.

S – Speech

• Ask a simple question, such as their name, age, or ask them to repeat a short sentence.
• Note symptoms such as:
  • Slurred speech or lisping.
  • Difficulty pronouncing words, unclear speech.
  • Using wrong words or not understanding the question.
  • Inability to speak in complete sentences.
• These are all signs of stroke that require urgent attention.

T – Time

• If the patient has any signs from the three steps above, call emergency services immediately and take the patient to a hospital capable of treating stroke.
• At the same time, try to remember or accurately determine when the symptoms began. This information helps doctors assess whether the patient is still within the golden hour for stroke treatment, thereby choosing appropriate intervention methods and improving the chances of recovery.

Part 2: How to correctly perform first aid and emergency care for stroke

Step 1: Call emergency services immediately if stroke is suspected

Contact emergency services immediately upon detecting signs of stroke

• Do not hesitate if stroke is suspected
  • As soon as you notice the patient showing signs of stroke or if the FAST test results indicate abnormalities, call 115 or your local emergency number immediately.
  • When contacting the operator, clearly state that you suspect the patient is having a stroke so that the emergency team can prepare appropriate treatment options.

Stroke is a medical emergency

• Every minute that passes without adequate blood and oxygen supply to the brain, millions of nerve cells can be damaged or die.
• Getting the patient to the hospital as soon as possible increases the chance of receiving treatment within the golden hour, which helps reduce the risk of death and limit long-term sequelae such as paralysis, speech disorders, or cognitive decline.

While waiting for the ambulance

• Keep the patient in a safe position, limiting movement unless necessary.
• Monitor consciousness, breathing rate, and signs of stroke to provide accurate information to medical personnel upon their arrival.
• Absolutely do not give the patient food, drinks, or medication without a doctor's instruction, as this can increase the risk of complications.

Step 2: How doctors diagnose stroke

Doctors will conduct an initial examination and assessment

• After the patient is admitted to the hospital, doctors will quickly gather information about the signs of stroke and when the symptoms began.
• The patient or family members may be asked about:
  • The time of appearance of the first symptom.
  • Symptoms such as facial drooping, arm weakness, speech difficulty, or vision loss.
  • Medical history such as high blood pressure, diabetes, heart disease, or previous stroke.
• This information helps doctors assess the severity and choose appropriate treatment methods.

Brain imaging to determine the cause of stroke

• Doctors often order imaging techniques such as:
  • CT scan of the brain to quickly detect hemorrhage or brain damage.
  • Brain MRI to provide a detailed assessment of the affected brain region and detect ischemic stroke early.
• Imaging results help differentiate between embolic stroke and hemorrhagic stroke, which in turn determines the appropriate treatment approach.

Brain and Heart Activity Monitoring

• In some cases, the doctor may order:
  • Electroencephalogram (EEG) to assess the electrical activity of the brain, especially when it is necessary to differentiate from other neurological conditions.
  • Electrocardiogram (ECG or EKG) to check heart rhythm and detect cardiovascular disorders, such as atrial fibrillation, which is a risk factor for stroke.

Assessment of Blood Flow to the Brain

• Doctors may perform diagnostic tests or techniques to check cerebral blood circulation and blood flow through the arteries.
• These results help identify the location of narrowing or abnormalities in blood vessels, and also support the development of treatment protocols and prevention of recurrent stroke in the future.

Step 3: Stroke Treatment Methods

The sooner the treatment, the higher the chance of recovery.

• After determining the type of stroke, the doctor will choose the appropriate treatment method.
• With stroke, time is a decisive factor. The sooner the patient receives treatment, the higher the chance of recovery and the lower the risk of long-term sequelae.
• Therefore, when stroke symptoms appear, the patient should be taken to the hospital immediately and should not self-monitor at home.

Thrombolytic drugs for ischemic stroke

• For ischemic stroke, some patients may be prescribed intravenous thrombolytic drugs (tPA) to dissolve blood clots causing blockages.
• This method is only applicable when the patient fully meets the professional criteria and is treated within the golden hour, usually no more than about 3 hours from the onset of symptoms (in some cases, the time may be extended at the doctor's discretion).
• Therefore, taking the patient to the hospital within the first 60 minutes after the appearance of stroke symptoms will increase the chance of timely evaluation and treatment.
• Research shows that patients treated with tPA at the right time have a better chance of recovery and reduced risk of long-term disability.

Treatment of Transient Ischemic Attack (TIA)

• If the patient is diagnosed with transient ischemic attack (TIA) or mild stroke, the doctor may prescribe:
  • Antiplatelet drugs to reduce the risk of blood clot formation.
  • Anticoagulants in some indicated cases, such as when the patient has atrial fibrillation or cardiovascular conditions that increase the risk of stroke.
• In addition to medication, patients are often advised to control blood pressure, blood sugar, cholesterol, and make lifestyle changes to prevent recurrent stroke.

Treatment of Hemorrhagic Stroke

• For hemorrhagic stroke, the treatment goal is to control bleeding, reduce pressure in the brain, and stabilize vital signs.
• The doctor may:
  • Use antihypertensive drugs if blood pressure is high.
  • Adjust or discontinue anticoagulants, antiplatelet drugs if they are the cause of increased bleeding risk and discontinuation is appropriate for the clinical condition.

Surgery in some cases

• Not all patients require surgery, but it may be a necessary option when:
  • Cerebral hemorrhage causes brain tissue compression.
  • There are vascular malformations or abnormalities requiring intervention.
  • Severe narrowing in the carotid artery or large blood vessels needs to be addressed.
• The decision for surgery will be considered by a specialist based on the type of stroke, the extent of brain damage, the patient's overall health, and the risk of complications for each patient.

References

1. American Heart Association. Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke.
2. American Stroke Association. Stroke Symptoms and Warning Signs.
3. National Institute of Neurological Disorders and Stroke. Stroke: Hope Through Research. National Institutes of Health.
4. National Institute of Neurological Disorders and Stroke. Know Stroke: Know the Signs. Act in Time.
5. National Institutes of Health. Stroke.
6. World Stroke Organization. Global Stroke Fact Sheet.
7. World Health Organization. Cardiovascular Diseases (CVDs): Stroke.
8. Centers for Disease Control and Prevention. Stroke: Signs, Symptoms, and Prevention.
9. European Stroke Organisation. European Stroke Organisation Guidelines for the Management of Acute Ischaemic Stroke.
10. Canadian Stroke Best Practices. Acute Stroke Management Evidence Tables and Recommendations.
11. National Health Service (NHS). Stroke.
12. Mayo Clinic. Stroke: Symptoms and Causes.
13. Merck Manual Professional Edition. Stroke (Cerebrovascular Accident).
14. MSD Manual Consumer Version. Stroke (Cerebrovascular Accident).
15. UpToDate. Overview of the Evaluation of Stroke.
16. Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke: Definitions for use in a multicenter clinical trial. Stroke.
17. Powers WJ, Rabinstein AA, Ackerson T, et al. 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke. Stroke.
18. Campbell BCV, Khatri P. Stroke. The Lancet.
19. Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization Global Stroke Fact Sheet. International Journal of Stroke.

Content editor: Leigh Kennedy Ly.

Information consulted and verified by expert: James Mitchell.