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3 subtle stroke symptoms you should never ignore

BE FAST is more than just an acronym to help you identify symptoms of stroke—it’s also a major clue to the type of symptoms you should never ignore. The mnemonic BE FAST stands for Balance, Eyes, Face, Arms, Speech, Time.

Although there are some common stroke symptoms that could have other causes, it’s the sudden onset of the symptoms that should raise a red flag that you or a loved one could be experiencing a stroke. And being able to spot those symptoms quickly can be the difference between life and death.

“What really distinguishes between a stroke and a non-stroke is the sudden onset of neurological deficits,” said Sam Laali, MD, a neurologist on the medical staff at Baylor Scott & White Medical Center – Grapevine. “A sudden onset of BE FAST symptoms should always raise the suspicion for stroke for yourself or your loved one.”

Related: Are you at risk for stroke? And how to lower your odds

Stroke’s more subtle symptoms

Although slurred speech, weakness and drooping on one side of the face or body are easily recognized stroke symptoms, some signs are much more subtle, including those that fall into the “B” and “E” part of BE FAST.

Balance

Symptoms that would fall into this category include:

  • Sudden loss of coordination
  • Trouble walking
  • Loss of balance
  • Dizziness or vertigo
  • Nausea and/or vomiting

According to Dr. Laali, these signs are often associated with cerebellar or posterior circulation strokes, which occur in the back of the head.

“Posterior circulation strokes can be tricky to recognize,” he said. “Not everyone with posterior circulation strokes—especially those involving only the cerebellum— will have ‘classic’ stroke symptoms such as facial droop, arm or leg weakness, or exhibit signs of aphasia, which is difficulty speaking or comprehending. To be safe, it is still important to get evaluated as soon as possible at your nearest emergency room.”

Eyes

Sudden trouble seeing out of one or both eyes should also be taken seriously and could be another possible sign of stroke. Dr. Laali said that problems with vision can be one of the more overlooked symptoms, because it’s not as readily known to the general public as a potential sign of stroke.

Strokes that involve the occipital lobes, located in the back of the brain, typically present with more of a visual phenomenon.

“Often, you have difficulty seeing one half of your world, and I’ve noticed that it’s hard for patients to accurately describe,” Dr. Laali said. “For example, they’ll say ‘Why can’t I see out of my left eye? But when you really test their visual fields, it’s actually the left half of both eyes.”

Just as with other stroke symptoms, it’s the sudden onset of vision problems that signals that they are likely stroke related.

“Any sudden vision loss should motivate you to seek immediate attention in an emergency room for the possibility of stroke,” Dr. Laali said.

Headache

Headaches are not part of the BE FAST acronym but are a common complaint in those who suffer from ischemic strokes, where a blood clot is cutting off blood to the brain. This type of stroke is the most common, accounting for roughly 85% of all strokes.

Additionally, severe sudden onset headaches and decreased level of consciousness can be seen with hemorrhagic strokes, which happen when a blood vessel in the brain bursts and causes intracranial bleeding. Hemorrhagic strokes account for the roughly remaining 15% of all strokes.

“When you’re dealing with a sudden onset headache that might be described as the ‘worst headache of your life,’ and also dealing with some of the signs and symptoms seen with ischemic strokes, that could indicate the possibility of a ruptured aneurysm, and you need to seek immediate care,” Dr. Laali said.

Related: Migraines? You might be at risk for a stroke

Don’t take “mini strokes” lightly

Sometimes BE FAST symptoms signal a TIA, or transient ischemic attack, often referred to as a “mini stroke.”

Previously, TIAs were defined based on duration of symptoms, as most TIAs last less than one hour and not usually longer than 24 hours. However, the definition has evolved over time, especially with improvements in imaging and MRIs, which have drastically cut the amount of time it takes to accurately diagnose a stroke. Now what distinguishes between a TIA and a stroke is cell death in the brain.

“When you actually see the MRI scan, that tells you that stroke has indeed occurred,” Dr. Laali said.

With both a TIA and stroke, a clot has formed somewhere in your brain, or formed elsewhere in your body and traveled to your brain. With a TIA, he said, the clot might come and go without causing any permanent damage. But that doesn’t mean TIAs are something to ignore.

“Sometimes a TIA or multiple TIAs are a very ominous sign that a permanent stroke is on its way,” Dr. Laali said.

It’s key to seek immediate emergency care so experts can get CT scans, MRIs and lab work to accurately diagnose you.

“Time is brain,” Dr. Laali said. “We are losing millions of neurons for each minute in which stroke is untreated.”

No matter what, he says, he tells every patient he encounters in the hospital setting: “In the future, if you think you’re having a stroke, don’t even hesitate. We’ll sort that out for you. Just come to the hospital right away.”

Find expert stroke care near you.

About the author

Sam J. Laali, MD
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Sam Laali, MD, is a neurologist and medical director of neurology at Baylor Scott & White Medical Center – Grapevine.

3 subtle stroke symptoms you should never ignore