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In Brief: Recognizing stroke early

In Brief

Recognizing stroke early

Early treatment of the most common type of stroke, the kind caused by blood clots, can limit brain damage and vastly improve outcomes. Yet some research suggests that fewer than 10% of ischemic stroke patients receive important clot-busting drugs. Those medications are most effective when given within three hours after symptoms start. Patients often arrive at the hospital after that window of opportunity has closed. They delay getting treatment for several reasons. Sometimes stroke symptoms may not be that pronounced. Other times they are mistaken as coming from other, less serious problems.

As a result, doctors are looking for ways to make it easier for the layperson to identify a stroke. The Cincinnati Prehospital Stroke Scale is one such attempt. Some experts say it leaves out too many symptoms — for instance, sudden confusion or trouble seeing out of one or both eyes. Others say it will cause false alarms because it's not specific enough. The first test in the scale is the so-called crooked smile test, but one of the first signs of Bell's palsy, a neurological condition, is also an abnormal smile.

Even so, the Cincinnati scale is a beginning. In one study, if any of the three tests that are part of the scale were abnormal, the chances that the person had suffered a stroke were about 70%. It's worth noting that people conducting the test were emergency medical technicians, not laypeople.

Cincinnati prehospital stroke scale

1. Crooked smile. Have the person smile or show his or her teeth. If one side doesn't move as well as the other so it seems to droop, that could be sign of a stroke.

1. Arm drift. Have the person close his or her eyes and hold his or her arms straight out in front for about 10 seconds. If one arm does not move, or one arm winds up drifting down more than the other, that could be a sign of a stroke.

2. Slurred speech. Have the person say, "You can't teach an old dog new tricks," or some other simple, familiar saying. If the person slurs the words, gets some words wrong, or is unable to speak, that could be sign of stroke.

Last updated:	September 05, 2008