Us and Them
I’m sure many of us survivors will know about the FAST mnemonic for stroke (brain attack) symptoms. FAST stands for Face, Arm, Speech and Time – the last letter a reminder to seek treatment immediately. I am aware that this mnemonic is not always helpful as some brain attacks can be less obvious. Take mine as an example. My wife called an ambulance and the paramedics checked me over. My face was fine. No drooping, no difficulty puffing out my cheeks. I had strength in my arms and my grip was OK. My speech and cognition was normal. They even put me on an ECG and that was normal, too. The main issues I had were balance (I couldn’t get off the floor), my eyes were fluttering around and I had extreme nausea. So, they diagnosed labyrinthitis (an infection of the inner ear that causes imbalance), gave me an injection of some anti-nausea drug, and went. It was only my GP, visiting me several hours later when other symptoms had kicked in, that diagnosed a stroke and I was rushed to hospital in another ambulance.
However, a study published in a recent issue of “Stroke” (February 2017) and authored by a resident physician at the University of Kentucky, might signal a change in how we educate lay people and first responders to look for stroke. Dr. Susanth Aroor was inspired by a conversation with Dr. Larry B. Goldstein (chairman of the University of Kentucky Department of Neurology and Aroor's mentor) to explore how many strokes were initially missed because the FAST mnemonic didn't apply to them. Like mine and many others.
The full article appears here:
They carried out a study of 736 people, and slightly more than 14% did not exhibit any FAST symptoms but were ultimately diagnosed with a stroke. They then looked at this 14% in more detail, focussing on the presenting symptoms for these “non-FAST” stroke patients, and identified two main symptoms; 1) problems with balance or gait (42% of the 14%) and, 2) sudden onset of visual problems (40% of the 14%). These findings have led the researchers at the University of Kentucky to propose the FAST mnemonic is changed to BEFAST (adding a B for Balance, and an E for Eyes).
The researchers found that if these two symptoms were added to the FAST mnemonic, the proportion of stroke patients not initially identified as having a stroke was reduced from 14% to 4.4%. Putting some numbers on these percentages brings this in to focus. Of the 736 people in the study, the FAST symptoms did not apply to 103 of them. If BEFAST had been used, then 71 people out of the 103 would have received a much earlier diagnosis. Thought provoking stuff.
Personally, I’m in total favour of ANYTHING that helps diagnose a brain attack as early as possible. I can only say that if the paramedics who initially dismissed my stroke as an ear infection had been trained in BEFAST and looked at my balance and my eyes, maybe I’d have been hospitalised 7 or 8 hours earlier than I was. If this was the case I might have received thrombolytic treatment to disperse the clot before it did irreparable damage. (This treatment needs to be done within a few hours of the blockage). We will never know if that would have made any difference. But I am sure it will make a difference to many people in the future . . .
Until next time,
“After all, we’re only ordinary men”