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Interviewer: Your ability to recognize strokes symptoms can make all the difference if a loved one has a stroke, especially for their quality life afterward. We'll talk about that next, on The Scope.

You know, there are some things that everybody should be able to do, CPR, first aid and recognizing signs of a stroke. Dr. Jennifer Majersik is the Director of the University of Utah Stroke Center and a stroke specialist. And unlike the other conditions, the faster you realize that somebody has a stroke and the faster you get them help, really affects the rest of their life in a way that like no other disease really does.

Time is Brain

Dr. Majersik: That's right because stroke has such a powerful impact on our lives both from a disability perspective and a quality of life perspective. And we actually have treatment. If you can treat a stroke early then you're less likely to have disability later.

Interviewer: I've heard time is brain.

Dr. Majersik: Right. I think that was coined about two decades ago right around the time that TPA was introduced which is the medicine for acute stroke. And if you are one of the very few people in the United States who receives TPA, you have 30% better chance or higher chance of having a better outcome. And that better outcome really matters. It's like walking out of the hospital going back to work, taking care of your family, not just wiggling your pinky or something that may not just critical to you, but things that really affect how you are able to take care of yourself and to live a full life.

Interviewer: So really as humans and members of the human race, all of us should be able to recognize when somebody we know or love is having a stroke because it really, truly could make you a super hero.

Signs of a Stroke

Dr. Majersik: That's what I call my patients who do recognize the signs of stroke or their family members. I've had numerous patients who they themselves didn't even know they are having a stroke, but their child or their neighbor, or their co-worker, even people at the gym, grocery store people, any passerby recognizes that someone is having a stroke and they make that decision to call 911. I've numerous times told me patients, "Please go back and find that person and thank them because they really made a difference."

Interviewer: Do people know a stroke when they see it?

Dr. Majersik: Sometimes and sometimes not.

Interviewer: Yeah, it's not like a rattle snake rattle where you hear that, you know.

Dr. Majersik: No.

Interviewer: Okay.

FAST Stroke

Dr. Majersik: So that most common signs of stroke, we use the acronym FAST. So FAST stands for face, arm, speech, and time, so the F is for face. So we ask people to smile and you see if their face is dripping on one side or the other.

Interviewer: So droopy face is a sure sign of a stroke?

Dr. Majersik: Well, not always. That's the trouble with anything neurologic.

Interviewer: This is tricky.

Dr. Majersik: It could be Bell's palsy. So I see a lot of patients who are coming in with, "My face is drooping. Is it Bell's palsy or stroke?" But the truth is that they should come in anyway.

Interviewer: If the face is drooping, call 911.

Dr. Majersik: You are not going to figure it out at home.

Interviewer: Okay. All right.

Dr. Majersik: It's going to take a specialist. Arms, we have people raise both arms and see if one doesn't raise or doesn't raise as high or drifts down after it goes up.

Interviewer: Okay.

Dr. Majersik: And then the last is speech. Speech is the most prominent symptom. So you look for someone who can't make speech or can't understand speech. So the speech could be slurred as if someone is drunk, but they aren't drunk. Or it could be misusing words or missing words up, they're backward. Sometimes it truly sounds like someone just took a whole bunch of words like confetti and threw them into the air and just randomly grabbed them out. They just don't make any sense at all. I've tried to imitate it for my medical students and I actually can't.

Interviewer: Okay.

Dr. Majersik: And the last is you talk to them or ask them to do something and they don't understand you. They can't make any sense of what you're saying. Their reception, their ability to receive speech is altered.

Interviewer: So let's pretend here for a moment we are sitting here and you have a stroke. Are you going to convulse, are you going to shake? What am I looking for? I know you told me FAST acronym.

What Does a Stroke Look Like?

Dr. Majersik: So unlike heart attack, which hurts in most people, particularly men but most people, stroke doesn't hurt and it doesn't look no one shakes and people typically don't call out as if having a seizure. It's very quiet. So you could be in a meeting and have a stroke and someone wouldn't notice except that they notice that you're not using your arm or maybe you notice you're not using your arm. I think for that reason, it's a bit of a quiet disease so it is very sudden onset, but it's not noisy and no one clutches their chest in pain. So they may say, "My arm feels funny. It's not moving right," but they're not going to be someone that everyone would notice on the street corner.

Interviewer: I understand that sometimes after a person has a stroke, they don't really know that they had a stroke or they don't even think they had a stroke. Explain how that's possible.

Dr. Majersik: There are some stroke syndromes, particularly in the right side of the brain, that involve recognition of your own body and of the disease processes that are going on. And so when your right side of your brain is having a stroke, you may be in complete denial that anything is wrong. I've had patients in the ER who can't move their left side and they are telling me they're going to go home. And I say, "You can't. You can't move your left side." And they say, "I'm still going home." They just don't get it. Patients who have a stroke on the other side of the brain typically do recognize it. So it just depends on which side that is hit because the brain is so specialized in all of its functions and locations.

Interviewer: Are there some common things that you hear your patients or family members say when they come to the hospital? Like, for example, "I thought it would just go away. I didn't actually think I was having a stroke. I just laid down for a second."

Dr. Majersik: Yeah, it's the bane of my existence really.

Interviewer: Yeah.

Dr. Majersik: So many, many patients ignore their symptoms. So the most common thing I hear is, "I just thought I'd take a nap. My arm was numb so I thought I'd take a nap." Or, "I was having slurred speech," or, "I couldn't see out the right side, but I kept driving because I had a really important appointment."

Interviewer: So those things, under no circumstances, are normal?

Dr. Majersik: It's not normal to not be able to see out of one side of your vision.

Interviewer: And you should do something about them immediately.

What to do if Someone is Having a Stroke

Dr. Majersik: Yeah. The best thing to do it to call 911. So, first of all, you shouldn't be operating a vehicle. I know that seems really obvious, but just in clinic yesterday, I had a guy tell how he just kept driving. It, again, kind of goes to that element of people not really recognizing how really serious something is. But if you call 911, the advantage rather than driving yourself, for example, is that ambulance, A, can keep you safe while you are in route. So they make sure your oxygen is okay and your blood pressure because a lot is going on when you're having a stroke.

And, second, they call the hospital ahead of time and they take you to a stroke center. They won't just take you to an ER that isn't just ready to take care of a stroke. They will take you to one that is ready. And they will call the hospital ahead of time and get the stroke team there in place. We were talking earlier about how time is brain. We only have three hours from the beginning of the stroke to the time when I'm no longer allowed to give that medicine, that TPA. And that includes from the very beginning of the stroke so it takes us a while in the hospital, up to an hour to get your head imaging, your labs and all that stuff. So you don't have a lot of time to waste. So we really want people to come via ambulance if at all possible.

Interviewer: Tell me if I'm right. The take away here is if you're experiencing any symptom of a stroke, which is you feel your face or somebody notices your face is dripping, if you can't raise your arm or put your arm up and it starts to drift down or your speech is slurred or jumbled words are coming out of your mouth, call 911 immediately.

Dr. Majersik: You got it.

Interviewer: Don't hesitate.

Dr. Majersik: You passed the test.

Interviewer: I passed the test. And the other thing I think that's important to take away is that strokes don't cause pain and there's no real other physical manifestation of it.

Dr. Majersik: That's right. It's a silent killer.

Other Warning Signs of a Stroke

Dr. Majersik: There are other additional signs of stroke that aren't in the FAST acronym, such as the vision loss or having trouble walking, being off-balance. And we focus on those main three, face, arm and speech because they're so common. But sometimes I've actually had people say, "Well, I've had those other symptoms, but I wasn't sure if they were related." Anything where you've lost function in your body suddenly, sudden onset, be concerned.

Interviewer: For no apparent reason, yeah.

Dr. Majersik: Right. So, if something has been very slow over the years or weeks or months, that's a little different. But if something was normal one minute and five minutes later it's abnormal that's when you should be concerned and be calling 911.

updated: September 29, 2021
originally published: August 19, 2015