Recognising a stroke
Stroke symptoms can vary in type and severity and sometimes people experience unusual symptoms (see 'The event' a stroke or TIA').
The Stroke Association recommend the FAST test to help recognise a stroke.
Use the Face-Arm-Speech Time test (FAST)
Three simple checks can help you recognise whether someone has had a stroke or minor stroke (Transient Ischaemic Attack - TIA).
If you see any of the following signs, call 999 immediately or 112 from a mobile.
F - Facial weakness' Can the person smile? Has their mouth or an eye drooped?
A - Arm weakness' Can the person raise both arms?
S - Speech problems' Can the person speak clearly & understand what you say?
T - Time to call 999.
Although the FAST campaign contains many of the most common signs of stroke, one person felt that it was not comprehensive enough.
Michelle experienced a TIA before her stroke and feels that her symptoms did not correspond to...
Michelle experienced a TIA before her stroke and feels that her symptoms did not correspond to...
Age at interview: 28
Sex: Female
Age at diagnosis: 26
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I was just wondering about that the TV campaign on the stroke, symptoms of stroke. Have you seen that? The…
The F.A.S.T?
Yeah, FAST. Have you found that, I mean, would you say that’s helpful? Is there something about it that doesn’t really ring with you? Or could be changed to make it more effective? It doesn’t mention TIA for example, and do you think that, there’s a need for more public awareness about …
Well, yeah, if more people knew about TIAs they could prevent stroke in the, in the first place, so I would tend to focus more on TIAs than the stroke itself.
But the F.A.S.T. advert, there’s, it does have its advantages but it, they don’t show all the signs and, yeah, you’ve got to act fast but it doesn’t necessarily just affect your arm or your speech, there’s a lot more to it than that.
So there’s lot of different symptoms and signs that you could miss because they’re not part of…
Yeah,
..that campaign?
Yeah, you would just be looking for the arm and the speech and... it’s not necessarily that.
Many people that we spoke to were not aware that they were having a stroke but most knew something was wrong and sought help. Younger people or people that had previously been fit and well did not recognise the symptoms or realise that they could be having a stroke. Those whose stroke had been due to high blood pressure often commented that it was a silent condition with no warning signs [Interview 01]. One older woman thought you would feel worse with a stroke and was surprised when the paramedics said they were taking her to hospital as she felt okay. In some cases, the person recognised they were having a stroke, but experienced long delays in getting help.
Susan recognised that she was having a stroke and called to her husband to get help but her...
Susan recognised that she was having a stroke and called to her husband to get help but her...
Age at interview: 67
Sex: Female
Age at diagnosis: 63
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But, in a very short space of time I had pins and needles going up my left side. Pins and needles in my head and realised that there was something quite serious going on. And worked out that as I didn't have a pain anywhere. Didn't have any pain at all, I wasn't sweating or anything like that. I felt perfectly normal except I had a lot of pins and needles in my head and down my left side and a little bit on my right side. So I thought, “Well, I'm probably having a stroke.” So I thought I'd better get blood to my head and laid down in this chair that switches (to) a recliner. And my face had started to go a bit numb on the left so I had to quite a job calling my husband (even though) he was just in the next room. So I was calling out, “[Husband’s name, husband’s name].” Stroke, ambulance.” And he said, “Speak up I can't hear you.” So I thought this was rather funny and he was still in the other room. So I kept (calling) “[Husband’s name] ambulance, stroke.” And he said, “Why do you always wait until I'm in the other room before you call me to do something.” So I thought, this is not good and yelled at the top of my voice as (best) I could, “[Husband’s name] come here!” And then managed to say, “I'm having a stroke, call the ambulance.” Still stayed horizontal in the armchair and I could feel the pins and needles creeping up heavily on the left side, and to a lesser extent on the right side. No other symptoms whatsoever. My mind was as clear as it ever is. It was purely the pins and needles which I guess meant that the blood wasn't getting to my brain somehow. It was very similar to when you sit with your legs in a cramped (position) and you don't move them for a long, long time. And then when you go to move your legs again, they hurt because the blood, wasn’t getting through properly. And they hurt until the blood's circulating again. That was the nearest likeness I can tell you of what it felt like. It was less on my right side and quite strong on my left side.
And the ambulance couldn't find us which was quite distressing. Although my husband was on the phone to the 999 person trying to direct them. And then because we're only half a mile from the doctor's surgery I thought perhaps I better get him to take me there in the hope that somebody was at the doctor's surgery. So, I had a little bit of strength left. I had enough strength to either go to the bathroom, which I wanted to do, or get to the front door. And I propped myself up on the wall in the hall and made my way to the front door and called [Husband’s name] to take me to the doctor's. And the ambulance and the doctor turned up at the same time just as I got to the front door. And I thought, “Oh I, I can't stand up anymore I’d better sit on a step. But because I've got arthritic knees I couldn't sit on the step, my knees wouldn't bend and I started falling backwards. And I realised I was going to go through my plate glass door so I put my left arm down to deflect myself away from the glass. And I was going quite numb by then, so I didn't really know I’d hurt it at that stage. I landed on it, it was tucked under me. I landed on it.
And the ambulance crew got me on the ambulance, on the stretcher from there and took me to hospital. But, I could talk in a peculiar way, with one side not working, enough to say my name and answer various other questions.
He was very appreciative of a friend because she phoned 999 quickly which meant there was little...
He was very appreciative of a friend because she phoned 999 quickly which meant there was little...
Age at interview: 58
Sex: Male
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Well, my stroke was in fact a brain haemorrhage. And, it came upon me without any warning. And I think the most extraordinary thing about it was that it wasn't as if there was any activity I was doing which was likely, or would have been thought likely, to endanger me. I was working very hard. I was approaching my sixtieth year and I wasn't working any harder particularly than I had over a long period of time. But one day I travelled to the North West of England and broke my train journey in order to see and old friend.
I was sitting in her kitchen drinking a cup of coffee and suddenly in the middle of drinking this cup of coffee I became aware that I was loosing my ability to articulate. I didn't know what had happened. In fact I was completely confused and bemused by it. But, the friend of mine who I was sitting with immediately got on her mobile phone to the emergency services and said that, she thought, she was very sorry, but she thought that the person she was just sitting with was having a stroke. And it was at that moment that I thought, 'My goodness, is this what's happening to me?'
Anyway her quickness and her general speed and alacrity of response helped me enormously because it got me into, onto an operating table much faster, I think, than is normally the case. But it think what I take away from that myself is that it is possible to be very ill indeed, suddenly without, even looking back on it, without any warning sign. And I suppose the reason is that what I had wrong with me was very high blood pressure which I now realise having examined this many times doesn't necessarily have any tell tale symptoms. You know, no sort of, no heart flutters, no things like that, no, you know, no obvious precursors to what in the end was a very severe illness.
Her daughter heard that her voice was slurred on the phone and got help. She felt okay and was...
Her daughter heard that her voice was slurred on the phone and got help. She felt okay and was...
Age at interview: 69
Sex: Female
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Well, I got up in the morning and I was feeling OK' and my daughter phones me every morning of course and she phoned but I'd, I got up, been to the toilet, put my dentures in, came through, put the kettle on and I was fine. And then my daughter phoned, I answered the phone, she said, 'Are you feeling OK the day, mum?' I said, 'Yeah.' She said, 'Your voice isn't right.' I said, 'Well, I feel OK'. She said, 'Have you got your dentures in?' I said, 'Yeah'. I said, 'Yeah'. She said, 'Mum, there is something wrong with you, your voice is just not right at all' so that was all I knew' but oh I forgot to tell you this. I have a chain on my door, which I always put on my door. Anyway, my daughter phoned my son and he came right down and on the, his road down, he phoned the ambulance to come and he was only two minutes in but he came to the door and at that time, they didn't all have keys' so , he buzzed of course and I let him in, came up and I tried with my left hand to open, I opened the door, the lock with the right hand, tried to get the thing out, the chain off, just couldn't, couldn't use this hand at all and by that time, he thought, I started crying and I'm saying, 'Oh, there is something wrong here', you know, but he said, 'Mum, can you not open the door?' I said, 'No, it's just the chain'. He said, 'Well, just take your time'. I said, 'OK'.
So then of course the door was open but I managed with this hand but no way was I ever going to get the chain off. So, and of course, by the time I came through here, and I felt this was a bitty different and I looked in the mirror and I saw and of course he told me that the ambulance was coming and I said, 'Well, I'm not going any place'. He said, 'You're going to the hospital mum, there's something far wrong with you' and whenever the ambulance man came in, he said what was my name and that, [my son] said, '[Mum]', ken. 'Mum, [Mum]' and he said, 'Well, Mum' and he said to the other, 'You'll have to go down the stair and get a chair'. I said, 'What for?' I said, 'I'm not going any place, I'm fine.' He said, 'No you're not, I think you've had a stroke' and then of course the tears came and all the rest of it but they were really awfully good, you know. But it was going down the stair, I was like in a push, a push chair like a baby [laughs] but anyway' I still, in my mind, I felt OK but in the ambulance, I felt there was something here, you know, that just wasn't, because this side, there was not a thing but then that was because the nurse said, 'Well, that was because there was nothing here', you know.
Occasionally friends, family and even passers-by spotted that the person was having a stroke. The landlord in a man's local pub had noticed a drop in his face and called an ambulance [Interview 28]. A woman had spoken to her daughter on the phone and the daughter knew something was wrong because her speech was slurred (See Interview 33 above). Several people whose speech had been affected realised they were having a stroke and had written it down to alert others to get help.
The landlord at the local pub noticed his face had dropped on one side and called an ambulance.
The landlord at the local pub noticed his face had dropped on one side and called an ambulance.
Age at interview: 63
Sex: Male
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Well, actually it was I went to the pub one Saturday afternoon, because we used to go Saturday afternoon to watch the horses, me and my brother and a couple of mates, we'd sit and watch the racing on the telly and I was ready to come home, you know, and the, the landlord said, 'I'll ring for a taxi' not taxi, 'I'll ring for an ambulance, you've had a stroke I think'. I said, 'I don't think I have'. He said, 'Your mouth has dropped down one side' it was this side I think and then somebody said, 'You look as if you've had a stroke'. He said, 'I'll ring for an ambulance', so they rung for an ambulance and took me to [the hospital] and I was there and I thought they'd say 'He's alright send him home' because I didn't feel as if I'd had a stroke.
Witnessing somebody having a stroke can be a very frightening experience and some people said that those around at the time understandably panicked. People were very appreciative that others had reacted quickly to get help and valued someone taking control of the situation and being calm and supportive until help arrived (See Interview 01 above).
Getting help
Most called 999 for an ambulance or called their general practitioner as soon as they experienced symptoms even if they did not know that it was a stroke.
For those who called an ambulance some experienced a long wait which became quite worrisome. One individual called 999 with much difficulty as he was limited in movement and speech.
Gavin was home alone when he suffered a haemorrhagic stroke. With much difficulty he managed to...
Gavin was home alone when he suffered a haemorrhagic stroke. With much difficulty he managed to...
Age at interview: 47
Sex: Male
Age at diagnosis: 45
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My wife and two children were out so I was on own in the house. And I guess I was pretty terrified at that time. I thought, “Oh my god and here I am. I’m collapsed. I’m having a stroke and I’m on my own. I’m not even sure if I can get to the telephone to dial an ambulance.”
But at this point my functions like speaking, thinking and just cognition were gradually plummeting if you like. The, the effects of the stroke were getting bigger and bigger all the time. I think I only had a few minutes to find the phone and dial the ambulance before I would’ve been mentally and physically incapable of doing it. So the phone was in the adjacent room and I managed to push myself along with my good leg and pull myself along with my fingernails along the floor with my good hand. And I managed to get to the legs of the table where the phone, where the chair where the, the phone was resting. And I reached up with my good hand and grabbed the phone and pulled it onto the floor. And at that point I can remember thinking, “Phew thank goodness I, I’ve at least got the phone now it’s just a simple question of pressing 999.” So I managed to press 999 and hold the phone to my ear. But of course I couldn’t support myself with my left hand so I ended up kind of rolling over on my back because I could, I had no sense of stability. And the emergency services answered the phone and said, “Which service do you require?” And I, I knew I had to say ambulance but I couldn’t speak very well. I’d love to hear a recording of what I actually said. I remember trying to say it and it probably come out, it probably came out something like ‘ambulance’. And the man guessed what I was trying to say and said, “Is it an ambulance you want sir?” And I, I sort of, “Yeah, yeah.” And he said, “OK ambulance. What is your address and post code?” So I knew I couldn’t say my address it was too long a, you know the road name and everything (address) was going to be too long. I couldn’t speak very well at all at this point and I knew I just had to say my post code. And luckily at this point only a minute or two after the stroke had happened, the effects hadn’t become so severe that I couldn’t remember my post code. I mean since then my short term memory and long term memory have been slightly affected. But I meant, I managed to remember my post code at that time.
And he managed to get enough of it. And then he said to me, “Can you open your front door and make sure that all the pets are in the back garden out of the way.” Because obviously they don’t want to open the door and be attacked by a huge dog. So I thought there’s no way I can get to the front door and no way I could stand up to open the front door. And I’ve only got chickens anyway and they’re hardly going to eat an ambulance man. So... I’ve got two cats but they’re, they’re not lions. So anyway. Sorry I’m waffling. So I lay there and just hoped that I’d done enough. And at the time I was doing my best to shout help or in the hope that a neighbour might hear me and come and be able to let the ambulance people in. And I remember scrapping at the wall trying to get up to open the front door because I was worried they’d have to sort of kick in the front door to get in. But I lay there for a couple of minutes and then heard the sirens and I knew that the ambulance was coming out the front of the house. And luckily they had the sense to go up into my neighbour’s garden, jump over the fence and come in the back door.
A few people put off phoning the general practitioner or going to Accident and Emergency (A and E) and some reflected that they should have got help sooner. One man's brother told him he should have phoned straight away as they can do more to help in the first few hours.
His brother told him that he should have phoned the doctor as soon as he felt unwell because more...
His brother told him that he should have phoned the doctor as soon as he felt unwell because more...
Age at interview: 59
Sex: Male
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Well, I woke up about 3 o'clock in the morning to go to the toilet, which is just through the door up the stairs and I felt' dizzy, giddy and I wondered what was wrong' then I sort of, sort of looked about me and realised there was something wrong. And I went, 'Right, the best thing I can do is get and lie down' so I just went back to my bed and apparently that's the worst thing you could do because you're supposed to contact the doctor within 2 hours and they've got a better chance of managing to do some more for you that way.
And when you went into the hospital, or first your brother arrived?
Yeah.
Did he know what was happening?
Well, he'd an, he'd an idea I had a stroke, because that's what I said to my brother, that was at 9 o'clock in the morning and he gave me a row because of that. He said, 'You should have phoned the doctor within 2 hours'.
Some people who had phoned their general practitioner had not been able to get help immediately particularly if it was out of hours. One man's wife was told to phone for an ambulance instead which came quickly. People who had contacted their doctor were often still taken to hospital. A few people were not taken to hospital because the stroke was not considered severe - in some cases this led to delays in getting tests and treatment.
Current advice is that everyone should be taken to hospital as soon as possible, regardless of severity of symptoms. If you do not pass the FAST test (see above) dial 999 or 112 from a mobile for an ambulance to get immediate assessment in hospital.
Many people were taken to A & E by ambulance or by a family member. Experiences of A & E varied, some felt that they were given priority because of a suspected stroke others experienced long delays. A woman whose husband had a severe stroke and went to a busy city A & E was frustrated that his form kept getting put back because people with heart attack were a priority.
People were often told that they had a stroke in A & E (see 'Getting a diagnosis').
Health professionals occasionally find it difficult to diagnose the stroke usually when the symptoms are mild or unusual. A woman who was a trained neurologist did not pick up on her mother's stroke until her speech started to become affected even though she suspects the stroke had occurred the previous day. An older woman's doctor was very apologetic that he had missed earlier balance problems which were the start of her stroke, but explained that strokes were sometimes difficult to diagnose.
Her GP apologised that he had not picked up that her balance problems were the start of her stroke.
Her GP apologised that he had not picked up that her balance problems were the start of her stroke.
Age at interview: 83
Sex: Female
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It was last June. I hadn't been feeling very well and I felt my balance was a bit stupid, I felt almost as if I'd been drunk walking sometimes [laughter]. Anyhow, I went up, I went to see my doctor and he did all the tests, you know, blood pressure, etc, etc. He said, 'No, you are fine' you know, 'Go ahead, you're absolutely fine' and I think he thought I was just worrying about nothing you see.
As I say, I hadn't been , I hadn't been feeling well , when I eventually went back up to my GP he said, 'I'm terribly sorry, I didn't catch, I didn't, I didn't spot it' and he said, 'Sometimes you don't, you know, it's not, you can't sort of diagnose it' but I think he was quite, he felt quite guilty because [laughter], you know, that same evening, after he'd seen me in the afternoon , but I wouldn't have anything against him, you know , it's just one of those unfortunate things I think. And if he had spotted it, he couldn't have done anything about it. It was going to happen and it happened [laughter].
A Pakistani woman who did not speak English was frustrated because when she went to hospital she was unable to explain her symptoms which she suspected were a stroke.
A woman who only spoke Punjabi knew her symptoms suggested a stroke but could not tell the doctor...
A woman who only spoke Punjabi knew her symptoms suggested a stroke but could not tell the doctor...
Age at interview: 76
Sex: Female
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Translated from Punjabi
When you didn't understand its stroke what did you think was happening?
I did realise it was stroke, doctors wouldn't believe it they said it's nothing.
Did you tell them its stroke?
I don't know English how could I tell them.
Your family?
Family, if someone came with me they could have said.
No one went with you?
My little grandson went with me. The doctor told him her blood pressure is high and we'll get her checked at the hospital. At the hospital they took blood twice and said it's nothing then sent me home.
A few younger people were upset when staff asked them whether they had been using drugs. Although they realised why these question were being asked they felt that they could have been dealt with more sensitively. One woman in her early 30s who had unusual visual symptoms was upset when they kept asking if her husband had hit her.
The staff in A & E did not realise her symptoms were due to stroke because she was young. They...
The staff in A & E did not realise her symptoms were due to stroke because she was young. They...
Age at interview: 31
Sex: Female
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Right. So we must have went by car to the hospital and I think at that point I still couldn't see a thing. No, I couldn't see a thing at that point. And we went into Casualty Department and I got took in right away and the hospital' were asking me things and I just, you know, my husband told him as well, what I've just said there and it must been throughout that night, I think I got kept in that night. I think throughout that night they were asking me the story over and over again and I was telling them exactly what had happened. I got up, I wasn't feeling too well, had a bit of a sore head, and then it got worse and worse and worse until a few hours later, it got really, really bad and I just told them the story and' they kept asking me if my husband had hit me over the head. At first, they were asking had I banged my head and I kept saying, 'No I have not banged my head, I just have a sore head'. But then they kept saying, 'Are you sure you've not had a bang to the head?' 'No'. Then they would ask my husband to leave the, the room, which I thought was a bit strange [laughter], then they said, 'Did, did your husband leave the room?' I said, 'No, is anybody listening to me, I just had a sore head'. And that went on for quite some time. So the next again morning I got let out and they said on the letter, it was a migraine.
Last reviewed June 2017.
Last updated August 2013
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