Stay Alert of Stroke with “FAST”

Dr. NG Ping Wing

Honorary Consultant in Neurology

Specialist in Neurology

As a severe neurological condition, stroke is the fourth leading killer in Hong Kong. It is also the most common cause of permanent disability in adults. Stroke is a common acute brain condition, as one out of four adults will suffer from it in his/her lifetime.

Blood vessel obstruction accounts for about 80% of stroke cases. About 2 million brain cells would die every minute when a major brain vessel is obstructed, “Time is brain”, or getting treatment fast, is crucial for the best possible treatment effect and clinical outcome.   

The Hong Kong Stroke Fund has long been using the preventive slogan “FAST” to promote public understanding of stroke symptoms. The word “FAST” stands for:

Face:      Beware of asymmetrical facial expressions.

Actions:  Note weakness in the limbs.

Speech:  Any difficulty with communication?

Time:      Call 999 for immediate assistance

The earlier the thrombolytic treatment is given for ischaemic stroke, the better are the therapeutic outcomes. For stroke patients, the so-called “3-hour” treatment window means immediate assessment and treatment as soon as the “F”, “A” and “S” symptoms occur. While the window may be longer in some stroke patients with large vessel occlusion, it is still true that “Time is Brain” and the patient should rush to the hospital right after the symptom onset.    

In about 20% of patients who present with mild symptoms initially, their condition will deteriorate in the next 72 hours. Hence, no matter how mild the symptoms are, timely assessment and proper treatment are of great importance for the best possible clinical outcome and recovery.

Seek Immediate Treatment Whenever Mini-Stroke Symptoms Occur

In patients with “mini-stroke” or transient ischaemic attack, the risk of developing a stroke within 3 months is up to 20%. As most symptoms disappear within an hour, patients are usually asymptomatic when they arrive at the hospital. No abnormality is found during clinical examination. 

Urgent evaluation and treatment must be provided to mini-stroke patients if they can give a clear description of their conditions. It is especially true for patients with “3 Highs”, i.e. high blood pressure, high blood sugar and high cholesterol levels. Recent clinical research suggests that patients with mini-stroke or mild stroke can benefit from a lower risk of recurrence and a better chance of full recovery if they receive dual antiplatelet therapy (DAPT) at the early phase.

Thorough Diagnosis of Causes of Headache

Headache is common among stroke patients. If you suffer from sudden, severe headaches, i.e. thunderclap headaches, brain CT scan is recommended to screen for the presence of subarachnoid haemorrhage. Other possible conditions such as reversible vasoconstrictive syndrome would require further examination for diagnosis.

While there are many causes of dizziness, some patients would worry about it as early signs of stroke. Dizziness (or spinning sensation) often arise from hind brain stroke, causing long vertigo spells, strong nausea, vomiting and unstable gait. With detailed clinical examination, other physical signs such as the accompanying loss of visual field or brain stem / cerebellar dysfunction might also be detected and help arriving at the accurate diagnosis.

Crucial Clinical Information Facilitates Accurate Diagnosis and Proper Treatment

Other stroke symptoms vary with the affected brain location, such as language problem, apraxia, hypersomnia, mental confusion, etc. Stroke mimics can also present with stroke-like symptoms and signs. It is important to rule out hypoglycemia, especially in patients with diabetes or alcoholism. Some conditions are more complex and even the doctors might be puzzled. Examples are hemiplegia or paralysis on one side of the body after focal epilepsy, migraine-induced motor aura, etc.

Complemented by blood test and brain scan results, accurate diagnosis hinges on thorough understanding of one’s medical history and vascular risk factors profile such as “3 Highs”, smoking, atrial fibrillation, etc. Doctors will weigh the pros and cons of different treatment options based on the information at hand and strive for the best possible care to patients without delay. 

Since 2016, IV Thrombolysis has been provided at HKSH on 24/7 basis to enhance recovery from ischaemic stroke. With the launch of Acute Stroke Activation Programme 2.0 in 2021, both IV Thrombolysis and Endovascular Thrombectomy are now performed for suitable patients through team effort and a multidisciplinary approach to improve clinical outcome. Early recognition of stroke symptoms is critical and the patients must act FAST to seek medical attention in the hospital.