Clinical Presentation

• Acute/ sudden changes 
• BE-FAST (this is taught to the community to help identify potential symptoms of a stroke) 
  1. B: Balance (gait abnormality) 
  2. E: Eyes (visual disturbances) 
  3. F: Facial droop (typically unilateral, uneven smile) 
  4. A: Arm weakness (typically will ask to raise both arms- will see unilateral arm drift) 
  5. S: Speech difficulty (slurred speech, difficulty finding words)
  6. T: Time (to call 9-1-1) 
• Other symptoms
  1. Numbness 
  2. Confusion 
  3. Headache with unknown cause

Assessment Scales

• Pre-Hospital Stroke Scale
  1. The Cincinnati Prehospital Stroke Scale (CPSS)
     • Evaluates: facial droop, arm drift, and speech 
  2. The Lost Angeles pre-hospital stroke screen (LAPSS)
     • Evaluates: facial paresis, hand grip weakness, and arm drift
• Hospital Stroke Scales 
  1. Glasgow Coma Scale (GCS) 
     • Measures level of consciousness in patients (developed to assess patients after traumatic injury) 
     • Evaluates: eye-opening, motor, and verbal responses
     • Scale ranges from 3-15 

2. National Institutes of Health Stroke Scale (NIHSS)
   • Gold standard and guideline recommended scale 
   • Measure of neurologic deficit to help assess stroke severity
   • Evaluates: Level of consciousness, response to commands, gaze, visual fields, facial movement, motor function, sensory, language including quality of speech, and inattention  
   • Scale ranges from 0 to 42. Higher numbers reflect a higher degree/severity of neurologic deficit. 

3. Modified Rankin Scale (mRS)

• Describes the degree of functional outcome after an individual experiences a stroke 
• Scale ranges from 0 to 6