AVC: Warning Signs and the FAST Test Explained by a Neurologist

Stroke is one of the leading causes of death and disability worldwide. Symptoms usually appear suddenly and can be mistaken for less serious conditions. Dr Stoica Vlad Mircea, a neurologist, explained to Digi24.ro how to recognise the warning signs and why every minute matters.

Rapid recognition of symptoms and calling 112 immediately are essential: the sooner medical intervention begins, the lower the risk of serious brain injury and death.

What is a stroke

A stroke occurs when the brain is damaged through one of two mechanisms: haemorrhage (rupture of a blood vessel, with blood entering the nervous tissue) or ischaemia (blockage of an artery, cutting off the supply of oxygen and nutrients). Its defining feature is the rapid onset of neurological deficit, in contrast to other conditions (tumours, autoimmune diseases) that develop gradually.

The main signs

• Facial asymmetry – drooping of one corner of the mouth, often accompanied by weakness or paralysis of the arm and leg on the same side of the body.
• Speech difficulties – problems with articulation or aphasia (difficulties with expression, understanding language, or both).
• Visual disturbances – sudden reduction or loss of vision, double vision, or restricted visual field. Sudden, painless loss of vision in one eye may indicate occlusion of the central retinal artery, an ischaemic emergency.
• Unsteady gait, sudden dizziness, loss of balance or coordination difficulties, particularly when they occur alongside other signs.
• Sudden, very severe headache with no known cause – common in certain types of haemorrhagic stroke, though not present in all cases.

A stroke may also be accompanied by a fall (with risk of head injury) due to loss of balance or paresis, or, less commonly, by an epileptic seizure. A person who has fallen should be kept in a safe position and not moved unnecessarily, unless they are in immediate danger or the 112 operator advises otherwise.

Transient ischaemic attack – a warning that must not be ignored

A transient ischaemic attack occurs when the brain experiences a temporary reduction in blood supply, producing symptoms similar to those of a stroke (speech deficit or reduced muscle strength on one side of the body). Symptoms typically last 15–30 minutes, up to around an hour, then resolve spontaneously without treatment. Precisely because the symptoms disappear, many people do not call an ambulance or go to hospital – which is a mistake, as this episode may herald a stroke. The doctor strongly recommends calling emergency services and undergoing a full hospital assessment to identify the underlying cause.

How the diagnosis is made

Diagnosis is established rapidly through clinical examination, neurological assessment, and imaging investigations. Doctors may use the NIHSS (National Institutes of Health Stroke Scale) to evaluate the severity of neurological deficit. Brain CT (computed tomography) is the most commonly used emergency investigation for distinguishing haemorrhage from ischaemia; depending on the case, CT angiography, perfusion imaging, or MRI may also be performed.

The FAST test – rapidly recognising a stroke

• F – Face: the person is asked to smile; drooping of one corner of the mouth or facial asymmetry are warning signs.
• A – Arms: the person raises both arms; inability to keep one arm raised may indicate sudden weakness or paralysis, sometimes extending to the leg as well.
• S – Speech: the person repeats a simple sentence; slurred speech or difficulties with expression or understanding may indicate an acute neurological problem.
• T – Time: if even a single sign is present, call 112 immediately.

There is also an extended version, BE-FAST, which adds B – Balance (sudden loss of balance) and E – Eyes (sudden visual disturbances).

The doctor emphasises that a person suspected of having a stroke should not be taken to hospital by private car if an emergency crew can be called, as the crew can begin assessment and care during the journey and notify the hospital in advance.

What to do if a stroke is suspected

The first step is to call 112 – without waiting for the person's condition to improve and without attempting to treat them at home. It is essential to note or remember the exact time the symptoms appeared; if this is not known precisely, note the last time the person was seen without any symptoms, as this information is important for determining treatment. No medication should be administered on one's own initiative before the emergency crew arrives – aspirin, for example, may be indicated in some ischaemic strokes but can worsen a cerebral haemorrhage. Even if symptoms resolve quickly, the person must be taken for urgent medical assessment, as it may be a transient ischaemic attack.

The main risk factors

Advanced age and family history cannot be changed. However, the following can be managed through treatment and lifestyle changes: poorly controlled high blood pressure, diabetes, raised cholesterol, and dyslipidaemia, all of which gradually affect blood vessels and can contribute to narrowing of circulation or clot formation. The risk increases when a person has several cardiovascular risk factors simultaneously, a situation frequently seen in metabolic syndrome. Other factors mentioned by the doctor include smoking, obesity, and physical inactivity.