Three Tests That Can Help Identify a Stroke

Ask an Expert: Three Tests That Can Help Identify a Stroke

Q: An e-mail is going around that says if you think someone may be having a stroke, you should ask him to perform three tests: to smile, to raise both arms and to speak a simple sentence. Can these tests really indicate a stroke, or is this an urban legend?

Answers from Ted Lowenkopf, M.D., medical director of the Providence Stroke Center: The “Three Simple Tests” e-mail may help to identify some strokes, but it’s not the best way to remember and recognize all of the signs of a stroke.

For reference, here is one version of the e-mail:

Remembering three simple tests could be a lifesaver!

Is it a stroke?

Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer brain damage when people nearby fail to recognize the symptoms of a stroke. Now doctors say any bystander can recognize a stroke by asking three simple questions:

  • Ask the individual to smile.
  • Ask him or her to raise both arms.
  • Ask the person to speak a simple sentence.

If he or she has trouble with any of these tasks, call 9-1-1 immediately and describe the symptoms to the dispatcher.

There are several concerns with this test. Specifically:

1. It doesn’t mention the importance of sudden symptoms. Other conditions can cause look-alike symptoms that persist for months or years. The key to recognizing stroke symptoms is that they appear suddenly, like an out-of-the-blue, lightning-bolt change. That's because strokes occur when blood flow to the brain is interrupted suddenly, whether by an artery blockage or rupture.

2. It leaves out some symptoms — a person can pass the test but still be suffering a stroke. The three questions cover the most-common symptoms of stroke, but not all of them. Other symptoms include sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, balance or coordination; or sudden, severe headache.

3. It doesn’t explain what kind of “trouble” to look for. A person could have “trouble” raising both arms for any number of reasons that have nothing to do with stroke.

When paramedics or emergency medical technicians (EMTs) ask suspected stroke survivors to lift both arms, they are watching specifically for "arm drift," or one of the arms losing elevation.

When paramedics ask a person to repeat a sentence, they are watching for language difficulties that are specific to stroke, including word-finding problems and slurred speech.

And when they ask a patient to smile, paramedics are watching to see if one side of the face doesn’t move symmetrically with the other side.

A better way: Act F.A.S.T.
The National Stroke Association promotes an easier way to remember the three tests for stroke, and offers more detail on what to look for with each test:

Act F.A.S.T.

  • Face – Ask the person to smile. Does one side of the face droop?
  • Arms – Ask the person to raise both arms. Does one arm drift downward?
  • Speech – Ask the person to repeat a simple sentence.  Are the words slurred?  Can he/she repeat the sentence correctly?
  • Time – If the person shows any of these symptoms, time is important.

Call 9-1-1 or get to the hospital fast. Brain cells are dying.

The best approach: Learn to recognize all of the signs of stroke
“Act F.A.S.T.” is easy to remember, but it still leaves out some important symptoms that could help you identify a stroke. The Providence Stroke Center advocates learning all of the official warning signs of stroke, as identified by the National Stroke Association. These signs include:

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden, severe headache with no known cause

This list may be harder to memorize, but it could help you recognize a stroke in time for you or a loved one to receive life-saving treatment.

Call 9-1-1 immediately if you have any reason to believe that someone is having a stroke — even if only one of these symptoms is present. If you have any doubts, the 9-1-1 dispatcher can help determine the nature of the emergency and send help as needed.

Updated March 2009