How to Respond to Signs of a Stroke

It’s crucial to act quickly before it's too late.

Man leaning against a wall with apparent vertigo

Medically reviewed in February 2022

Updated on February 15, 2022

Stroke is the fifth leading cause of death and a major cause of disability in adults in the United States. Stroke takes the lives of over 150,000 Americans each year, with one American dying from stroke every three-and-a-half minutes, on average.

Stroke can accompany COVID-19 as well. Among older people infected with the coronavirus, the risk of stroke is highest within the first three days after diagnosis. In severe COVID-19, the risk of a bleeding stroke quadruples. And in rare cases among people under 50, stroke can reportedly hit within a couple of months of even an asymptomatic COVID-19 bout.

These are startling statistics. But if you remember to act fast at the first sign of a stroke, you can increase the chances of survival.  Here’s what to do if you think someone is having a stroke. (Teaser: Call 911.)

The basics of stroke
Stroke is caused when a part of the brain is deprived of blood flow, and therefore doesn’t get enough oxygen. The result is that part of the brain either stops working properly or dies.

Stroke can happen in two ways:

  • A blood clot in the brain causes what’s called an ischemic stroke. These account for 87 percent of all strokes.
  • Bleeding in the brain causes a hemorrhagic stroke. This happens in about 13 percent of all strokes.

Understand B.E. F.A.S.T. to spot the signs of a stroke
Every minute counts when it comes to stroke. The sooner treatment starts, the better the chances of survival and recovery.  

“We, as physicians, like to give [clot-busting] medication within four hours of stroke onset, because we know it works better and the outcomes are better,” says Virginia-based emergency medicine doctor Peter Paganussi, MD. “We really try to give it in under two hours, if we can.” 

How can you tell if someone is showing signs of a stroke? Know the acronym B.E. F.A.S.T.:  

  • Balance: Is the person suddenly uncoordinated or having trouble with balance?
  • Eyes: Is the person having suddenly blurred or double vision, or sudden, painless vision loss in either or both eyes?
  • Face: Drooping or numbness on one side of the face is a common stroke sign. Ask the person to smile and see if the smile is uneven. 
  • Arms:  Is there arm weakness? Ask them to raise both arms. Does one arm drift down? 
  • Speech:  Slurred speech is also a stroke sign. Ask them to repeat a simple phrase, such as “The sky is blue.” Can they do it? 
  • Time:  If any of these signs is present, call 911 immediately. Call even if the symptoms go away. There may have been a mini-stroke, which can warn of a bigger stroke to come.

Sometimes, a severe headache or vertigo (the feeling that the world is spinning around) can signal a stroke, too.  

What to do—and what not to do
It bears repeating: Call 911. The sooner you alert healthcare professionals, the better.

“The biggest piece of advice I can give is to call 911 immediately and let the operator know it’s possibly a stroke,” says Jeff Wagner, MD, a neurosurgeon and the Stroke Program Director at Swedish Medical Center in Denver.

As soon as the symptoms start, check the time, so you’re able to tell the medical team, he adds.

You might think it’s faster to get in the car and head to the hospital on your own, but that certainly isn’t safe if you’re the one having symptoms. And if it’s another person you’re calling about, it’s better to wait for a medical crew. They will know which nearby hospital is best equipped to handle stroke, and they can also call ahead to the emergency room so that providers there are ready and waiting.

In addition, Wagner says, paramedics “can start doing treatments that can make a difference on the way to the hospital.”

Treatment should happen quickly
Some strokes are treated with a minimally invasive procedure to extract the clot. For most strokes, the most effective treatment is a blood thinner and clot-busting drug called tPA, or alteplase. It’s more effective if given within a few hours after symptoms first start, and testing has to be done first to ensure that the benefits will outweigh the risks in a given patient. That’s why it is critical that stroke victims get to the hospital fast.

Article sources open article sources

Centers for Disease Control and Prevention. National Center for Health Statistics. Deaths and Mortality. Page last reviewed January 13, 2022.
American Heart Association. 2021 Heart Disease and Stroke Statistics Update Fact Sheet.
American Heart Association. Stroke risk among older adults highest in first 3 days after COVID-19 diagnosis. February 3, 2022.
Yang Q, Tong X, Schieb L, et al. Vital Signs: Recent Trends in Stroke Death Rates - United States, 2000-2015. MMWR Morb Mortal Wkly Rep. 2017;66(35):933-939. Published 2017 Sep 8.
Quintanilla-Sánchez C, Salcido-Montenegro A, González-González JG, Rodríguez-Gutiérrez R. Acute cerebrovascular events in severe and nonsevere COVID-19 patients: a systematic review and meta-analysis [published online ahead of print, 2022 Feb 10]. Rev Neurosci. 2022.
Tu TM, Seet CYH, Koh JS, et al. Acute Ischemic Stroke During the Convalescent Phase of Asymptomatic COVID-2019 Infection in Men. JAMA Netw Open. 2021;4(4):e217498.
American Stroke Association. Stroke Symptoms. Accessed February 10, 2022.
American Stroke Association. Hemorrhagic Stroke (Bleeds). Accessed February 10, 2022.
American Stroke Association. Ischemic Stroke (Clots). Accessed February 10, 2022.
Debbe Geiger. Know the Signs of Stroke - BE FAST. Duke Health. Updated September 23, 2021.
Aroor S, Singh R, Goldstein LB. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic. Stroke. 2017;48(2):479-481.
Centers for Disease Control and Prevention. Know the Facts About Stroke. Page last reviewed May 3, 2021.

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