How to Tell If Someone Is Having a Stroke

A stroke is an emergency. Spotting its signs could dramatically improve a person’s chances of recovery

Ingrid Wickelgren

Reviewed by

Selma C. Kunitz, Ph.D.

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En español

Published January 30, 2024

A woman with a headache sitting in a chair at home

FG Trade / Getty Images

Video: How to Spot Symptoms of a Stroke

Yael Shvetz, 53, was sick in bed in her Hillsborough, New Jersey, home in April 2022. The mother of four had a piercing headache, and her migraine medicine wasn’t helping. Worse, she’d been throwing up for hours. She’d had migraines before, but never with this kind of vomiting. She thought she’d eaten some bad chocolate pudding.

When Shvetz tried to get out of bed, she fell to the floor with a thud. Her children quickly called 911. By the time the paramedics arrived, Shvetz was barely functional. “My brain was foggy,” she says. “I was mumbling and going in and out of remembering and knowing what I was doing and saying.”

No one knew it then, but Shvetz had had a stroke. A blood vessel in her brain had burst. Deprived of oxygen, brain cells were dying rapidly. “You lose roughly 2 million brain cells every minute a stroke is happening,” says William “BJ” Hicks, M.D., a vascular neurologist and codirector of Riverside Methodist Hospital Comprehensive Stroke Center in Columbus, Ohio.

Given this fast rate of damage, the sooner a person gets treatment, the more likely they are to avoid severe brain damage or death. “Stroke is the number one cause of disability in adults in the United States … especially if the patient is not getting to the hospital quickly,” Hicks says.

Detecting the symptoms

The challenge is that some symptoms of a stroke can easily be misinterpreted. Headaches and vomiting, for example, are shared with other, often less deadly conditions. In Shvetz’s situation, “the paramedics thought I was dehydrated, so they took their good ol’ time,” she says. Numbness, dizziness or disorientation can also come on suddenly, then disappear. This may be a sign of a transient ischemic attack, or TIA, a short-lived stroke that still needs immediate attention, as it can be a warning sign that a more serious stroke is on the horizon.

A brain bleed like Shvetz’s is called a hemorrhagic stroke. “People will tell you, ‘It’s the worst headache of my life,’ and they will often get nauseated and throw up,” says David Miller, M.D., an interventional radiologist and codirector of the stroke center at the Mayo Clinic in Jacksonville, Florida. Hicks likens it to a pipe bursting inside the skull. Pressure builds, causing pain. The pain Shvetz experienced is not typical of the more common ischemic stroke, in which a clot stops blood from reaching brain tissue, Miller says. Ischemic strokes make up 87 percent of cases, according to the Centers for Disease Control and Prevention.

Still, Shvetz had some of the telltale signs of both types of stroke. Doctors use the acronym B.E.F.A.S.T. for these common signs. Encounter one or more, and you should take quick action:

B – balance loss

E – eyesight change

F – face drooping

A – arm weakness

S – speech difficulty

T – time to call 911

Here’s how doctors describe what you might see:

B – balance loss: A person may suddenly fall like Shvetz did, unable to get up, Miller says. This was what alarmed Shvetz’s 17-year-old daughter, who found her mom on the floor and had to get her older brother to lift their mom back into bed. If it’s a stroke, the loss of coordination is likely to be on one side of the body. For instance, a hand or arm on the same side may be clumsy. If a person is holding something in that hand, they may drop it and be unable to pick it up, Miller says. Shvetz’s stroke was in her right brain, which controls the left side of her body. But that wasn’t apparent from her fall.

E – eyesight change: A person may suddenly lose peripheral vision, or their eyes may drift over to one side rather than aiming straight ahead.

F – face drooping: One side of the person’s face may sag noticeably. Ask the person to smile. If one side of the face smiles but the other side does not, you should suspect a stroke.

A – arm weakness: To check for weakness, ask the person to hold up their arms in front of them, to the side or above the head. If they can’t lift one arm or an arm starts to drift down, they may be having a stroke. Same goes for the legs. The person may have trouble lifting one leg while sitting in a chair or lying on the ground.

S – speech difficulty: A person’s speech may be slurred or slow. “If you have them try to speak or repeat or name things and they can’t get the words out quickly, as quickly as they normally can, those symptoms are classic for a stroke,” Hicks says.

If the stroke hits the language areas of the brain, the person’s speech may stop making sense or they will not be able to talk at all, Miller says. They should be able to understand simple commands, such as “show two fingers on your right hand,” or “smile,” Miller says. “If they can’t do that, that’s a very quick and early sign that they’ve got a big problem, and it may well be a stroke.”

The T is especially important — time to call 911: “It’s not time to dial my office. It’s not time to dial your neighbor. It’s not time to dial a relative. It’s time to dial 911,” Hicks says. Getting to a stroke team at a hospital quickly can limit the loss of brain tissue and expand options for treatments. Some of those treatments must be given within a few hours. “Timing is very, very important,” Hicks says.

The biggest mistake people make is not calling for help immediately, Hicks says. “If it bothers you enough to think, Something’s not right with this person, then you should call 911,” Miller says. “I would rather go down [to the emergency department] 10 times to find out it’s nothing … than have somebody come in the next day with a stroke I can’t fix.”

Though Shvetz’s children called 911, she says no one suspected a stroke until after she arrived at the hospital. Shvetz had to be moved to a second hospital that was better equipped to handle her stroke. That meant lost time.

Still, she was lucky. After brain surgery to stop the bleeding, followed by an induced 10-day coma, she gradually recovered over the following months, learning to speak, write and walk again. Today, she says her only remaining problem is some hearing loss resulting from the brain surgery. “I’m driving. I went back to work.” She walked a 5K in June. “Other than my hearing on my right side, I’m back to me.”

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Ingrid Wickelgren is a science journalist and author specializing in biology and medicine. Her work has appeared in numerous publications, including Scientific American, Science and Quanta.

Selma C. Kunitz was founder of the health research company KAI Research (now Navitas Clinical Research), which provides clinical research services to the National Institutes of Health and industry. Before retiring in 2020, she supported studies in stroke, traumatic brain injury, multiple sclerosis, Parkinson’s disease, arthritis, autism and more.