The Sign That FAST Forgot

Three cartoon frames: 1 a stick figure holds its hands to its face 2 raises its arms 3 starts counting 1, 2, 3, 4 ...

There’s a well known acronym, FAST, for recognizing and acting on possible stroke symptoms. Here’s the version from a website of the UK National Health Service.

  • Face – the face may have dropped on one side, the person may not be able to smile or their mouth or eye may have drooped
  • Arms – the person with suspected stroke may not be able to lift one or both arms and keep them there because of arm weakness or numbness
  • Speech – their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake
  • Time – it is time to dial 999 immediately if you see any of these signs or symptoms.

But is FAST enough? The list must be brief: there are many possible symptoms and who will remember them all? I certainly can’t. And FAST does one thing supremely well. It raises awareness of the need for rapid treatment. A stroke is a medical emergency and immediate attention is crucial to minimize its effects.

The factor that it plays down is loss of vision.

One night I felt a bit odd. I had some vision disturbance, a bit like the migraine aura I suffer from occasionally, and there was also an undefinable sense of confusion. I wondered if I was having a stroke. I had a rough idea about the signs. I couldn’t remember the details (and certainly not the FAST acronym), but I must have read the advice somewhere, and a few bits must have stuck.

So as in the cartoon pictures above I rubbed my face, did a BIG grin, lifted both arms above my head, swallowed nervously (can I speak?) and counted aloud to 10 (yes I can!). No paralysis or weakness apparently, and I could talk fine, so I decided it wasn’t a stroke. I had passed FAST.

A bit later I noticed I had lost a good deal of my vision. I still didn’t make the connection for quite a while. I remember thinking how surprising it was that my peripheral vision must have been deteriorating in recent years and I hadn’t really noticed. It wasn’t until I stood next to someone and was oblivious to their presence, until I turned my head, that I had a bad shock. Something was very different all at once.

But I still didn’t know that sudden vision problems are another common symptom of stroke. Otherwise I would have gone to the hospital at once, rather than waiting to see my doctor in the morning.

In a fascinating interview for ABC Dr Alex Leff of the University College London Institute of Neurology suggests that sudden vision loss may be the third commonest symptom of stroke.

So what could be the signs that someone near you had suddenly lost vision because they were experiencing a stroke? Many sources of advice do mention vision, usually along the lines of sudden vision problems in one or both eyes. From what I’ve read, in both eyes would be particularly significant, because it suggests the problem lies in the brain, not the eyes themselves.

But of course people who are having a stroke often don’t recognize it properly, because they will naturally be confused. Even a mild stroke that leaves the patient relatively self-aware, as I certainly was, still impairs judgement and analysis (as was the case with me).

If you reread the FAST symptoms you will notice that they are written from the outside, from the perspective of an observer who is witnessing someone having a stroke. So it uses ‘the person’, ‘their’ and so on. It’s entirely sensible to write it as though we are observing, for the reason explained above, but I think the patient’s perspective is also needed.

Vision problems are more difficult for a bystander to spot. Unless the person affected complains about not being able to see properly or starts bumping into objects, the symptoms may not be obvious.

And it still needs to be useful for self-diagnosis – the patient’s perspective, as I wrote above. If a V had been in my vague recollection alongside F, A and S, it could possibly have made a difference.

FAST is also written in a rather impersonal way that people may find it hard to relate to actual situations with people they know (even themselves). It’s a bit like something Bertrand Russell said about the difference between knowledge by description and knowledge by acquaintance.

Perhaps it might be better to try and describe how both parties – the patient – and the friend nearby – would experience it. That might help with the self-diagnosis aspect and also be something that would strengthen understanding of what to be alert to in other people.

So I was pleased to find this at the Heart and Stroke Foundation

What the victim might feel:

“One minute I was reading my book and the next I couldn’t make out a word. I knew this was serious, so I just stayed where I was and called my husband. Actually, I didn’t trust myself to get up.”

What the observer might see:

“She looked helpless. When I came to her, she was having trouble finding me visually. I asked her how many fingers I was holding up and she told she couldn’t see my hand. I called 911 and waited with her.”

I like that. It captures something that could resonate more with people.


About partialinsight

One evening I had a stroke. Half my sight vanished overnight. Adapting made me grasp how amazing the visual system and brain are. It also taught me to understand disability completely differently and I'm grateful for the lesson.
This entry was posted in Blindness and visual impairment, Stroke, Disability, Cognition and tagged , , , , , , , , , , , , , , , . Bookmark the permalink.

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