Stroke: the symptoms and what to do in the first minutes

A stroke comes on suddenly: someone who was talking normally a minute ago cannot lift an arm or say a simple sentence. You can recognise the symptoms of a stroke within a minute, with no medical training. This guide covers what they are, how to do the FAST test and what to do until the ambulance arrives. The first step is always the same: call 112 straight away.

Stroke symptoms: what you see

What they have in common is that they appear suddenly. The three best known:

• Face: one side droops. The mouth is lopsided and the smile is uneven.
• Arm: weakness or numbness in one arm, often in the leg on the same side too.
• Speech: the words come out slurred, the person cannot find words or does not understand what you say.

Some symptoms are rarely linked to stroke. When they appear suddenly, they are just as serious:

• blurred vision or loss of sight in one or both eyes
• dizziness, loss of balance, trouble walking
• confusion
• a very severe headache with no obvious cause
• nausea or vomiting together with any of the above

They do not all have to be present. One is enough to call 112.

The FAST test, step by step

FAST is a quick check anyone can do.

1. F – Face. Ask the person to smile. Does one side of the face droop?
2. A – Arms. Ask them to raise both arms in front of them. Does one drift down, or not lift at all?
3. S – Speech. Ask them to repeat a simple phrase. Are the words slurred, can they not speak, or do they not understand you?
4. T – Time. If you see even one of the three, call 112 straight away.

Some organisations add two checks in front, balance and eyes, and call it BE-FAST.

The test is not a diagnosis; it helps you decide quickly. If it shows nothing but you think something is wrong, call 112 anyway. The staff there can guide you or put you through to the duty doctor of EKAB, the national ambulance service.

What to do straight away

1. Call 112. Say you suspect a stroke and describe what you see.
2. Note the time the first symptoms appeared. Doctors need that time to decide on treatment.
3. Lay the person on their side, in the recovery position, with the head slightly raised and supported.
4. Stay with them. Speak calmly and watch whether they respond to you and breathe normally.
5. Get ready for the ambulance. Gather the medicines the person takes, so the crew can see them, and send someone to meet the crew at the entrance.

What not to do

• Do not wait for it to pass. Even if the symptoms ease, the person needs a hospital.
• Do not give food or water. A stroke can affect swallowing, and the person may choke.
• Do not give any medicine, including aspirin. Without tests nobody knows whether the stroke is caused by a clot or by bleeding, and in the second case aspirin can do harm.
• Do not drive the person to hospital, and do not let them drive. In an ambulance, care starts on the way.

Mini-stroke: why it is an emergency even if it has passed

What people call a mini-stroke is a transient ischaemic attack (TIA). The symptoms are the same as a stroke, but they last from a few minutes to a few hours and resolve fully within 24 hours.

The symptoms passing does not mean the danger has passed. A TIA is a warning: the person is at high risk of a full stroke in the near future. And while the symptoms last, nobody can tell whether they will go away. Call 112 as you would for a stroke, even if the person feels well by the time the ambulance arrives.

Ischaemic and haemorrhagic stroke: why time matters

In an ischaemic stroke a clot blocks a blood vessel and part of the brain is left without blood. In a haemorrhagic stroke a vessel bursts and blood leaks into the brain. From the outside they look the same: the symptoms are identical and only a hospital can tell them apart.

What you do is the same in both cases. Time matters because the treatments that reopen a blocked vessel can only be given within the first hours after the symptoms start. Every minute of delay means more damage.

If the person becomes unresponsive or stops breathing

• Unresponsive but breathing normally: keep them on their side, in the recovery position, and keep checking their breathing.
• Unresponsive and not breathing normally: tell 112, put the phone on speaker and start CPR. Ask someone to fetch a defibrillator (AED).

The steps are described in Cardiac arrest or heart attack: the difference and what to do.

Preventing a stroke

The most important risk factor is high blood pressure. Others are smoking, diabetes, high cholesterol, atrial fibrillation (a common irregular heartbeat), obesity, an inactive life and heavy drinking.

Prevention comes down to a few things: have your blood pressure checked, do not smoke, be active regularly, eat a balanced diet with less salt, limit alcohol. If your doctor has prescribed treatment for blood pressure, blood sugar or your heart, take it without gaps.

Remember one thing

Face, arm, speech. If any of the three changes suddenly, call 112 and note the time. Do not wait, do not give anything by mouth, do not leave the person's side.

Learn the steps hands-on

You learn CPR and how to use a defibrillator through hands-on practice in the Life Support Hub BLS course.

This article is for information and does not replace specialised training.