Someone is mid-sentence, and a word comes out wrong. One side of the mouth sits lower than the other. The tea cup tilts because the hand will not hold it. Stroke warning signs are often sudden, and they are a reason to get emergency help even when the person asks to lie down for a while first.
A stroke happens when blood supply to part of the brain is interrupted, or when there is bleeding in the brain. Families do not need to decide which of those it is. Both are emergencies. Time matters because assessment and treatment depend on how long the symptoms have been present.
Signs that should change the afternoon
Look at the face. Ask them to smile, if they can follow that. One side may droop. The eyelid or the corner of the mouth may hang.
Ask them to lift both arms and keep them up. One arm may drift down, or they may be unable to lift it. Weakness can also show up in a leg, as a sudden inability to stand or a fall to one side.
Listen to speech. Words may be slurred, the wrong word may come out, or they may not understand a simple request. A person who was talking clearly a few minutes ago and now cannot find a sentence needs emergency care.
Other sudden changes belong on the same list. Sudden loss of vision, in one eye or part of the visual field. A sudden severe headache, especially if it is unlike their usual pain. Sudden loss of balance, dizziness, or trouble walking that arrived all at once.
You do not need every sign at once. One clear sudden change is enough to call.
What to do while you wait
Note the time the symptoms started, or the last time someone saw them well. If they woke with the signs, the time they went to sleep is the last time they were known to be well. Write it down. Emergency staff will ask.
Do not give food. Do not give water, tea, or medicine crushed into a drink. Swallowing can be unsafe even when the person looks alert, and a later assessment is harder if the stomach is full of a well-meant meal. Speech and swallowing after the emergency phase are discussed in speech and swallowing after stroke.
Do not give aspirin. A stroke can be caused by bleeding, and a household cannot tell the difference. Leave that decision to the clinicians who can assess them.
Do not drive them yourself if someone else can get emergency help to the house, or if a driver who is not the sick person can take them when emergency services cannot reach you quickly. The person with symptoms should not be the one at the wheel.
Keep them in a safe position, usually sitting or lying on their side if they are vomiting or drowsy, so the airway stays clearer. Loosen tight clothing around the neck. Do not leave them alone to "sleep it off."
When the signs fade
Sometimes the droop, the weak arm, or the muddled speech lasts minutes and then seems to disappear. The person may insist on finishing lunch. Symptoms that fade still need emergency assessment the same day. A short episode can be a warning of a stroke that has not finished announcing itself.
Do not wait to see whether it returns in the evening. Do not send them to a routine clinic slot next week as the first step. Tell the responders, or the emergency department, that the symptoms came and went, and give the times.
A severe headache with vomiting, a seizure, a collapse, or rapidly worsening drowsiness belongs in the same emergency response. So does chest pain that might be a heart attack rather than a stroke. Those symptoms are described in heart attack symptoms. If you are unsure which emergency you are seeing, call anyway.
After the emergency assessment
Home exercises and speech practice start only when a clinician has said that home is safe. Until that point, the job is the emergency call and the time the symptoms began.
Bring a list of medicines and allergies if you can do it without delaying the call. Tell staff about blood thinners, blood pressure tablets, and diabetes medicine. Do not start or stop any of those while you wait.
