We thank Dr Huwez for highlighting the deficiencies of the Face Arm and Speech Test (FAST), which records the presence of acute facial paresis, arm drift or abnormal speech, in diagnosing posterior circulation strokes.
The FAST is a useful screening tool in the community because most strokes involve the anterior circulation and therefore affect at least one of the three components measured by the FAST. However, for the important minority of posterior circulation strokes (and some anterior circulations strokes), function of the face, arm and speech may not be affected and hence the FAST may not alert the observer to the diagnosis of stroke.
We welcome efforts by Dr Huwez and colleagues to examine the predictive value of common symptoms of posterior circulation stroke (e.g. vertigo, ataxia, diplopia, hemianopia) for stroke and to develop and validate a formula that optimises the sensitivity of the FAST for diagnosing all strokes in the community without compromising specificity unacceptably.
Competing interests:
No competing interests
10 February 2015
Graeme J Hankey
Professor of Neurology
David J. Blacker
The University of Western Australia
Harry Perkins Institute for Medical Research, QEII Medical Centre, Perth, Australia 6009
Rapid Response:
We thank Dr Huwez for highlighting the deficiencies of the Face Arm and Speech Test (FAST), which records the presence of acute facial paresis, arm drift or abnormal speech, in diagnosing posterior circulation strokes.
The FAST is a useful screening tool in the community because most strokes involve the anterior circulation and therefore affect at least one of the three components measured by the FAST. However, for the important minority of posterior circulation strokes (and some anterior circulations strokes), function of the face, arm and speech may not be affected and hence the FAST may not alert the observer to the diagnosis of stroke.
We welcome efforts by Dr Huwez and colleagues to examine the predictive value of common symptoms of posterior circulation stroke (e.g. vertigo, ataxia, diplopia, hemianopia) for stroke and to develop and validate a formula that optimises the sensitivity of the FAST for diagnosing all strokes in the community without compromising specificity unacceptably.
Competing interests: No competing interests