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STEFANIE RAGASE

Signs of Stroke: A personal account

My dad’s stroke scare.

“The neurologist wants to talk to you. He says I need to go right into surgery and wants me to transfer me to Toledo, but I told him I wanted to come to OhioHealth Riverside in Columbus…to be near my daughter.”

That was the call I had been waiting for. A few hours earlier, my mom let me know she took my dad to the hospital, as he couldn’t see well or walk.

The neurologist from Lima hopped on the call and explained that my dad had a stroke and needed higher neurology expertise than he could provide.

Hi, I’m Stefanie. I’m a healthcare marketer at OhioHealth with a focus on neuroscience. I’m a mom to a toddler that loves her grandpa and wants him here forever. And I know that if the roles were reversed, he’d want the best and fastest option for his little girl – not the most convenient. So I told him matter-of-fact – “Daddy, I agree with the doctor. We need to get you to the closest Comprehensive Stroke Center, which happens to be in Toledo. I’m right behind you. I’ll see you in just a few short hours. I love you, and you’re in great hands.”

I moved fast. I packed up my laptop, ran out of my OhioHealth office, and within the hour had coordinated daycare pickup, a babysitter until my husband got off work, packed enough clothes for one night, filled up my tank of gas, and started the three and a half-hour car trip to Toledo from Columbus.

If you or someone around you shows any signs of a stroke, it’s imperative to be fast and seek care immediately.

The signs of stroke are B.E. F.A.S.T

Balance: loss of balance or coordination
Eyes: trouble seeing out of one or both eyes

Facial weakness
Arm weakness
Speech difficulty
Time

TIME. The last letter of the B.E. F.A.S.T. signs of a stroke acronym. Going from Lima to Toledo would be faster than to Columbus. And every minute saved meant he could potentially save millions of brain cells. This decision could mean his life.

Here’s what we know. Dad’s onset of symptoms is indicated in acronym letters B and E. He first had severe eye pain and double vision, followed by balance issues that progressed to not being able to walk. His symptoms started 20 hours before he went to the emergency room in Lima. Still, he should have gone immediately – and that’s the message I want to share.

It was confirmed that he had an ischemic stroke due to severe blockage and a clot on his brain’s left side. Within one week, dad enrolled in outpatient rehab and barely needed his cane. Within one month, he returned back to work. He had his follow up visit at the OhioHealth Stroke Prevention Clinic at Riverside Methodist Hospital and will go back in the fall for an annual checkup.

The neurologist said that dad’s outcome was “lucky”. I feel it was a miracle. And we know how lucky we are he is here with us today, considering he waited too long to seek care.

B.E. F.A.S.T. – learn and teach the signs of stroke and save a life!

On my refrigerator is an OhioHealth magnet I worked on with the words B.E. F.A.S.T. I remember a couple of years ago, my dad asking me about the signs. It was a brief conversation. And now I want EVERYONE who enters my home to see it. You can help someone recognize the signs of stroke and save a life.

In recent years OhioHealth has evolved its stroke education to include two new acronyms – B and E to change the signs of stroke acronyms to B.E. F.A.S.T. This follows the National Institute of Health’s recommendations. Expands to include the less common, but deadly signs.

We talked to Nirav Vora, MD, OhioHealth chief of vascular neurology, and now my dad’s follow-up neurologist, about how to spot a stroke, and why swift action is so important.

Balance: loss of balance or coordination

A stroke to the back of the brain can cause vertigo, which is an acute presentation of the stroke. “At first, it may seem like an inner ear problem, but if it’s sudden, we really need to consider stroke as a first diagnosis,” says Dr. Vora.

“In that algorithm, you don’t catch strokes that happen in the back of the brain, which accounts for 20-25% of strokes, and can be the deadliest of strokes.”

Eyes: trouble seeing out of one or both eyes

Part of this sign of stroke has to do with vision. A stroke to the back of the brain can compromise vision on one side of the visual field and develop a blind spot. “It’s hard to perceive, but if you can recognize it, it’s a disabling stroke symptom that rarely recovers. So acting fast and seeking medical attention can reverse permanent injury,” says Dr. Vora.

Vora said that a stroke to the back of the brain can also cause double vision, which may feel like blurry vision.

Facial weakness

A very common symptom to the front or back of the brain will cause weakness. When you have poor blood flow on one side of the brain, you may develop weakness on the opposite side of the face, causing a facial droop.

Spot the stroke

“The real way to tell if you have a facial droop is to look into a mirror – or a cell phone in selfie mode – and smile,” says Dr. Vora, “Both sides of the face should elevate in the smile appropriately, and if they don’t, it could mean a stroke.”

You can also look at the crease between the nose and the lips. We all have a natural crease. In a true stroke, you will see a flattening of the crease, or the crease will go away.

Arm weakness

Hand-in-hand with facial weakness is weakness of the limbs. You may develop weakness on one side which can be examined by looking at the upper extremities.

Spot the stroke
Ask someone to hold their hands in front of them as if they are holding a lunch tray or a pizza box. What you’re looking for is for arms to reach the same level. If one arm drifts or sags below, or if they have to use their shoulder to get their hand up to the same level, it would indicate a stroke.

Speech difficulty

Depending on where the stroke happens in the brain, you may experience:

  • The context of speech is normal, but it doesn’t sound clear – like slurred speech. It may not have clarity.
  • Incomprehensible speech and doesn’t make sense.
  • Loss of speech.

Spot the stroke

To test speech, ask someone to say things they would typically easily know such as:

  • Ask them their address
  • Ask them to say the “Pledge of Allegiance”

What you want to pay attention to is:

  • Is the pace the same that is normal for that person, or is it slower than usual?
  • Are they saying each word distinctively, or are they missing certain letters? Such as instead of saying Pledge of Allegiance, they say Cledge of Allegiance?
  • If you ask them to say the Pledge of Allegiance, do they make sense? Or are they responding with something out of context?
  • Are they able to say and think of the words at all?

Time to call 9-1-1

The “T” in B.E. F.A.S.T. is all about the action you need to take – time to call 9-1-1. If someone is presenting one or many of these signs of stroke, calling 9-1-1 and getting them to the closest emergency room is critical. The EMS team will evaluate the symptoms and take the patient to the nearest emergency room or stroke center that is best depending on where the patient is.

“From when the symptoms of stroke start, we have four and a half hours or 270 minutes to get them to the nearest hospital,” says Dr. Vora, “but the treatment is most effective within 60 to 90 minutes and can even reverse the most severe strokes,” he says.

About the author

Stefanie Ragase is an experienced healthcare marketing and communications manager at OhioHealth with a professional focus in neuroscience, and a personal passion for health and wellness. Her job is to connect people to the right resources at the right time throughout their wellness journey. She brings a unique perspective to her neuroscience communications role as a care partner for her father, a stroke survivor, and her younger sister who lives with multiple sclerosis. Stefanie is a mom to 3-year-old Nora and lives in Lewis Center with her husband, Trey.

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