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.
Gerard Bulger FRCGP FRACGP
Competing interests: No competing interests