How to Detect a Stroke FAST


If you ever see ads on buses and billboards for how to spot a stroke in someone, you might see the acronym FAST.

There’s a reason it’s caught on. The letters each stand for something that could help you recognize a stroke and save someone’s life. The last letter, T, stands for “time,” because stroke is a time-sensitive emergency.

"Time is so critical,” says Michael Mullen, MD, Assistant Professor of Neurology at Penn Medicine. “Minutes can absolutely make a difference. We have very effective treatments for stroke, but they are most effective immediately after the symptoms start. The longer people wait to come to the hospital, the less effective our treatments will be."

How to detect a stroke FAST

If possible, try to note the first time you see symptoms. That information can help physicians determine treatment options, the National Stroke Association says.

FAST stroke

What causes a stroke

A stroke occurs when a blood vessel in the brain has a clot or ruptures. This deprives part of the brain of blood and oxygen, so brain cells quickly start to die.

"Over time, that portion of the brain will go from dying to dead,” Dr. Mullen explains. “Some areas affected by the stroke will die very quickly, but other areas will hold on over a period of time. As more time goes by though, those areas will also start to die."

The longer a person goes untreated, the more irreversible the damage is to the brain,” he says.

Every single second counts

stroke FAST

“It’s estimated that the typical patient loses 1.9 million neurons, or brain cells, for every minute that the stroke goes untreated,” Dr. Mullen points out. “And you can’t get those back.”


Getting to the clot

An ischemic stroke, which affects 85 percent of people who have a stroke, is caused by a clot blocking a blood vessel. When this happens, there are two types of treatments that can be used to re-open the blood vessels and restore blood flow to the brain. The firs a clot-busting medication called tPA, or tissue plasminogen activator. This medication can be given within 4.5 hours of symptom onset and can dissolve the clot, says Dr. Mullen.  

Penn Medicine has received the Target Stroke Honor Roll award: Over a 3-month review, at least 50% of eligible stroke patients received tPA in 60 minutes or less after arriving at the hospital.

That quick treatment could make a huge difference. “Over time, the benefits of using tPA diminish,” Dr. Mullen says. “If you get the tPA at 90 minutes, then your outcome is much better than at 3 or 4 hours.  We want to use tPA as early as possible to maximize our patients’ chances of a good recovery.”

"The other option we have for ischemic strokes, is endovascular thrombectomy,” Dr. Mullen says.  That’s where trained physicians use a thin, flexible wire and a retrievable stent to physically remove the clot from the blocked artery. This intervention is more resources intensive that tPA, and requires treatment at a specialized center like the Comprehensive Stroke Center at the Hospital of the University of Pennsylvania. "Endovascular thrombectomy can be performed up to 24 hours after symptom onset," Dr. Mullen says. But, just like tPA, treatment with thrombectomy is time dependent and earlier treatment improves the chances for a good outcome. 

Patients who have suffered a stroke have access to the most advanced resources available for the treatment of stroke. Penn’s team of stroke physicians evaluate, diagnose and treat stroke and other diseases affecting the blood vessels in the brain in Philadelphia and surrounding regions. The Penn Stroke Team also has partnerships with many area hospitals who transfer stroke patients to our Comprehensive Stroke Center and provide stroke consultations through telestroke to area hospitals as needed. 

Hemorrhagic stroke

A hemorrhagic stroke happens when a blood vessel in the brain ruptures or tears. There are two main types of hemorrhagic stroke. The more common one is known as intraparenchymal hemorrhage or intracerebral hemorrhage, as the NIH notes. It occurs when the blood vessel bursts in the brain and bleeds into its parenchyma, or neural tissue.

On the other hand, a subarachnoid hemorrhage happens when a blood vessel bursts right outside of the brain and the bleeding leaks into the space between the brain and the skull.

Both types of hemorrhagic strokes can lead to brain cells dying because the leaked blood causes swelling of the brain and more pressure in the skull, the NIH explains.

High blood pressure is a leading cause of hemorrhagic stroke, particularly intraparenchymal hemorrhage. Treatment might include medication to lower your blood pressure, in an effort to slow or stop the bleeding in your brain, the NIH says.

Hemorrhagic strokes can also be caused by blood thinners known as antithrombotic drugs, such as warfarin. Those are commonly prescribed for problems like swelling or blood clots in a vein. If you have a hemorrhagic stroke while taking a blood thinner, your physician will immediately stop your medication as part of your treatment.

A potential cause of the less-common subarachnoid hemorrhage is a ruptured aneurysm—a swollen blood vessel that bursts. When this happens, surgery might be done to place a type of metal clip on the blood vessel to stop the bleeding.

Certain endovascular procedures might also help, the AHA/ASA says. These are less invasive treatments performed within the blood vessels using a catheter or other devices.

Like ischemic strokes, hemorrhagic strokes are dangerous and require fast treatment. Otherwise, they could result in long-term brain damage, and even death.

The takeaway

If you’re showing symptoms of a stroke or think a friend is, don’t wait even a few minutes. Call 911 right away. Quick treatment could save your friend’s life and greatly improve his quality of life later.

Every stroke is different, but one thing that’s universal with all strokes is that time is critical. As Dr. Mullen stresses, “The sooner you get treatment, the better chance you have at a good outcome.

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