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The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms?

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The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms?
Nayer Jamshed
Published on: 29 April 2016
The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms?
Nayer Jamshed
Published on: 29 April 2016

Published on: 29 April 2016
The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms?
- Nayer Jamshed, emergency physician
- Other Contributors:
  Dr Fouzia F Ozair
We read with great interest the article by A. Ross Naylor et al ; the face arm speech test: does it encourage rapid recognition of important stroke warning symptoms? This study helps in generating awareness of the early stroke symptoms in the population. Similar studies were done in the past like Cincinnati prehospital stroke scale (CPSS) which had a positive predictive value between 72%-85%.1 Los Angeles Prehospital stro...
Show More

We read with great interest the article by A. Ross Naylor et al ; the face arm speech test: does it encourage rapid recognition of important stroke warning symptoms? This study helps in generating awareness of the early stroke symptoms in the population. Similar studies were done in the past like Cincinnati prehospital stroke scale (CPSS) which had a positive predictive value between 72%-85%.1 Los Angeles Prehospital stroke screen and ABCD2 score are other studies with a good positive predictive value.2,3 Despite these milestone studies and various awareness programs conducted we are miles away in getting the desired results. Since the Food and Drug association has approved the thrombolytic therapy for acute ischemic stroke only less than 5% have received this therapy. This was mainly because of the unawareness of early stroke symptoms in majority of the patients which landed them out of the therapeutic window period of three hours.4 An early non contrast CT scan of the head, to rule out haemorrhage along with a normal blood sugar is required to start thrombolytic therapy. In up to 35%-53% patients of acute stroke of less than 3hrs duration subtle CT findings like hyper dense MCA, obscuration of lenticular nucleus and loss of grey white interface can be observed. However these findings are not mandatory to start thrombolytic therapy.5,6 Population awareness programs regarding identification of early symptoms of stroke, effective ambulance services, smooth transition, coordination between emergency physician, neurologist and neuroradiologist is indispensible for early treatment to reduce mortality, morbidity and disability. References 1. Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. "Cincinnati Prehospital Stroke Scale: reproducibility and validity." Ann Emerg Med 1999 Apr;33(4):373-8
2. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS)." Stroke 2000 Jan; Kidwell CS, Starkman S, Eckstein M, Weems K, Saver JL. "Identifying stroke in the field. 31(1):71-6. 3. Johnston SC, Rothwell PM, Huynh-Huynh MN, Giles MF, Elkins JS, Sidney S, "Validation and refinement of scores to predict very early stroke risk after transient ischemic attack," Lancet. 2007; 369:283-292.
4. O'Connor RE, McGraw P, Edelsohn L. Thrombolytic therapy for acute ischemic stroke: why the majority of patients remain ineligible for treatment. Ann Emerg Med. 1999;33:9 -1
5. Keith W. Muir et al. imaging of acute stroke. Lancet Neurology. 2006; 5:755-766. 6. Gyanendra Kumar et al. Penumbra, the bas of neuroimaging in acute stroke treatment: current evidence. Journal of Neurological Sciences. 2010; 288:13-24.
Conflict of Interest:
None declared
Show Less

Conflict of Interest:
None declared.
- Back to top
Published on: 29 April 2016
The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms?
- Nayer Jamshed, emergency physician
- Other Contributors:
  Dr Meera Ekka,Dr Fouzia F Ozair
We read with great interest the article by A. Ross Naylor et al ; the face arm speech test: does it encourage rapid recognition of important stroke warning symptoms? This study helps in generating awareness of the early stroke symptoms in the population. Similar studies were done in the past like Cincinnati prehospital stroke scale (CPSS) which had a positive predictive value between 72%-85%.1 Los Angeles Prehospital stro...
Show More

We read with great interest the article by A. Ross Naylor et al ; the face arm speech test: does it encourage rapid recognition of important stroke warning symptoms? This study helps in generating awareness of the early stroke symptoms in the population. Similar studies were done in the past like Cincinnati prehospital stroke scale (CPSS) which had a positive predictive value between 72%-85%.1 Los Angeles Prehospital stroke screen and ABCD2 score are other studies with a good positive predictive values.2,3 Despite these milestone studies and various awareness programs conducted we are miles away in getting the desired results. Since the Food and Drug association has approved the thrombolytic therapy for acute ischemic stroke only less than 5% have received this therapy. This was mainly because of the unawareness of early stroke symptoms in majority of the patients which landed them out of the therapeutic window period of three hours.4 An early non contrast CT scan of the head, to rule out haemorrhage along with a normal blood sugar is required to start thrombolytic therapy. In up to 35%-53% patients of acute stroke of less than 3hours duration subtle CT findings like hyper dense MCA, obscuration of lenticular nucleus and loss of grey white interface can be observed. However these findings are not mandatory to start thrombolytic therapy.5,6 Population awareness programs regarding identification of early symptoms of stroke, effective ambulance services, smooth transition, coordination between emergency physician, neurologist and neuroradiologist is indispensible for early treatment to reduce mortality, morbidity and disability. References 1. Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. "Cincinnati Prehospital Stroke Scale: reproducibility and validity." Ann Emerg Med 1999 Apr;33(4):373-8
2. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS)." Stroke 2000 Jan; Kidwell CS, Starkman S, Eckstein M, Weems K, Saver JL. "Identifying stroke in the field. 31(1):71-6. 3. Johnston SC, Rothwell PM, Huynh-Huynh MN, Giles MF, Elkins JS, Sidney S, "Validation and refinement of scores to predict very early stroke risk after transient ischemic attack," Lancet. 2007; 369:283-292.
4. O'Connor RE, McGraw P, Edelsohn L. Thrombolytic therapy for acute ischemic stroke: why the majority of patients remain ineligible for treatment. Ann Emerg Med. 1999;33:9 -11.
5. Keith W. Muir et al. imaging of acute stroke. Lancet Neurology. 2006; 5:755-766. 6. Gyanendra Kumar et al. Penumbra, the bas of neuroimaging in acute stroke treatment: current evidence. Journal of Neurological Sciences. 2010; 288:13-24.
Conflict of Interest:
None declared
Show Less

Conflict of Interest:
None declared.
- Back to top