Intended for healthcare professionals

Practice Easily Missed?

Posterior circulation ischaemic stroke

BMJ 2018; 361 doi: (Published 19 April 2018) Cite this as: BMJ 2018;361:k1185

Re: Posterior circulation ischaemic stroke

One reason that these posterior strokes are missed is the reliance of the F.A.S.T (Face Arms Speech Time) rapid screening test. I have seen missed cases of posterior strokes where F.A.S.T was applied and was negative (a Vth nerve lesion with "dizziness" and headache being described). The negative FAST falsely reassured first responders, and later no clinician assessed what was meant by dizziness, nor was there a HINT test. The importance of defining dizziness by testing eye movements was correctly emphasised in this paper. The case report shows than an initial diagnosis was made of migraine. I summise this was because there was no arm weakness, nor speech problems and facial droop. Drop the FAST test; it seems that its application could miss up to 20% of strokes.

Yours faithfully

Gerard Bulger FRCGP FRACGP


Competing interests: No competing interests

23 April 2018
Gerard Bulger