Emergency neurological assessment in which rapid imaging differentiates ischemic from hemorrhagic stroke after sudden facial droop, arm weakness, and speech disturbance (FAST).
Indication
- Sudden facial droop, arm or leg weakness, speech disturbance (FAST)
- Sudden vision loss, double vision, or blurred vision
- Sudden onset severe headache (suspicion of hemorrhagic stroke)
- Sudden loss of balance, dizziness, gait disturbance
- History of transient ischemic attack (TIA / mini-stroke)
- Patients at risk: atrial fibrillation, carotid stenosis, hypertension
Preparation
- Stroke is an emergency; no preparation is needed — go to the hospital immediately
- The time of symptom onset must be noted (critical for the treatment window)
- Current medication list (especially blood thinners) must be known
How it's performed
- The severity of neurological deficit is determined using the NIHSS scale
- Emergency brain CT or MRI is performed to differentiate ischemic from hemorrhagic stroke
- Vascular imaging (CT angiography) is used to identify large vessel occlusion
- In ischemic stroke, intravenous thrombolytic therapy (tPA) may be administered within the first 4.5 hours
- In large vessel occlusion, mechanical thrombectomy is considered up to 24 hours
- In hemorrhagic stroke, blood pressure control and surgical consultation if needed
Post-procedure
- Intensive monitoring in the stroke unit during the first 24-72 hours
- Early physical therapy, speech therapy, and occupational therapy
- Secondary prevention with antiplatelet/anticoagulant therapy
- Management of blood pressure, cholesterol, diabetes, and atrial fibrillation
- Neurological follow-up and functional assessment at 1, 3, and 6 months
Risks
- Permanent motor, speech, or cognitive deficit
- Bleeding risk with tPA therapy (symptomatic intracranial hemorrhage approximately 6%)
- Vessel injury or embolism during thrombectomy
- Bedridden complications such as aspiration pneumonia, deep vein thrombosis
- Risk of recurrent stroke (especially in the first year)
FAQ
What should I do if I notice stroke symptoms?
Apply the FAST rule: facial droop, arm weakness, speech disturbance. Call emergency services immediately. Time is brain.
Can thrombolytic therapy be given to every patient?
No. The patient must arrive within the first 4.5 hours, have no brain hemorrhage, and not have certain contraindications. The physician evaluates each patient individually.
Is full recovery possible after a stroke?
With early intervention and regular rehabilitation, significant recovery may be achieved; however, permanent deficits may remain.
How can recurrence be prevented?
Risk is reduced through control of blood pressure, cholesterol, and diabetes; smoking cessation; regular antiplatelet/anticoagulant therapy; and annual follow-up.
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