Looking out for speech disturbance may be the most important stroke sign

With COVID-19 protocols, fewer in-person doctor visits and ubiquitous face masks make tell-tale signs of stroke like facial drooping and arm weakness harder to detect.

Across the world, fewer people are going to the hospital to be treated for stroke, but that’s not because fewer people are having them. In July, Renyu Liu, a professor of anesthesiology and critical care in the Perelman School of Medicine published a study in CNS Neuroscience & Therapeutics that found that since the start of the COVID-19 pandemic, the global average for stroke hospitalizations decreased by about 42%, statistics spurred by people afraid to seek emergency medical care for fear of catching COVID-19. In a recently published editorial in the same journal, Liu suggests that that the pandemic, with its social distancing and mask wearing, may be also be contributing to a decline in people recognizing the common warning signs of stroke.

Traditionally, FAST (face, arms, speech, time) has been the acronym used to educate the public about stroke symptoms. Liu points out that this acronym puts its greatest emphasis on symptoms that are harder to notice during the pandemic: Facial drooping is one of the common signs of stroke, but it might not be noticeable it on someone who is wearing a mask, or standing far away. With a major shift to more video chats as a main means of communication, speech disturbance may be the only sign of stroke people might readily be able to pick up on.

Liu and his collaborators suggest an alternative to the FAST acronym, which places facial drooping and arm weakness ahead of speech disturbance. Liu proposes the adoption of Stroke 9-1-1 (S911), a novel program, where “S” represents “stroke” and “speech disturbance” while urging people to immediately call 911. The nine also stands as a reminder to get people to spell n-i-n-e to verify slurred speech, the one stands for one weak arm, and the second one stands for one uneven face, i.e. a crooked mouth.

This story is by Sophie Kluthe. Read more at Penn Medicine News.