[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Nervous system](https://durgical.com/en/clinical-exam/#a-neuro) › Recognising a stroke: BE-FAST and the NIH Stroke Scale [Clinical exam](https://durgical.com/en/clinical-exam/) · [Nervous system](https://durgical.com/en/clinical-exam/#a-neuro) # Recognising a stroke: BE-FAST and the NIH Stroke Scale - Topic Sudden signs of a brain attack: balance, eyes, face, arm and speech; every minute counts. Updated 2026-11-01 **See it in 3D:** [Middle cerebral artery](https://durgical.com/en/anatomy/middle-cerebral-artery/) · [Anterior cerebral artery](https://durgical.com/en/anatomy/anterior-cerebral-artery/) · [Posterior cerebral artery](https://durgical.com/en/anatomy/posterior-cerebral-artery/) · [Cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/) · [Motor cortex](https://durgical.com/en/anatomy/precentral-gyrus/) ## Key points - BE-FAST: Balance, Eyes (vision), Face (drooping), Arm (drifting), Speech and Time (onset time and calling emergency services). - Balance and eyes were added to FAST so as not to miss posterior circulation strokes. - Record the time the patient was last known well: it defines the treatment options. - NIHSS: 11 items (consciousness, gaze, visual fields, face, arms, legs, ataxia, sensation, language, dysarthria, extinction); scored 0 to 42, higher is more severe. - Before blaming a stroke, check the capillary glucose: hypoglycaemia mimics it. - If symptoms clear within minutes it may be a transient ischaemic attack, which is also an emergency. ## What it is A stroke is a sudden loss of brain function from a blocked or ruptured vessel. Early recognition is decisive, because reperfusion treatments work only in the first hours. BE-FAST is a rule for spotting it in and out of hospital, and the National Institutes of Health Stroke Scale (NIHSS) measures its severity in a standard way. ## Key facts - Ischaemic stroke: the most common type, from a thrombus or embolus. - Haemorrhagic stroke: intracerebral or subarachnoid haemorrhage; a sudden, very severe headache suggests subarachnoid haemorrhage. - Non-contrast head CT separates ischaemic from haemorrhagic stroke. - Stroke mimics: hypoglycaemia, seizure with post-ictal paralysis, migraine with aura, tumour. ## Step by step - B (balance): 'Do you feel dizzy or unsteady? Can you walk?' - E (eyes): 'Are you seeing double, or have you lost vision in one eye or to one side?' - F (face): ask the patient to smile or show the teeth and look for asymmetry. - A (arms): ask the patient to raise both arms with the eyes closed and watch for one that sinks. - S (speech): ask the patient to repeat a simple phrase and listen for slurred, odd or absent speech. - T (time): record the onset or last-known-well time and activate the stroke code or call emergency services. - In hospital, the full NIHSS is given in its fixed item order, without going back to change scores. ## Clinical notes - Middle cerebral artery: face and arm weaker than leg, aphasia if dominant hemisphere, neglect if non-dominant. - Anterior cerebral artery: the opposite leg weaker than the arm. - Posterior circulation: vertigo, ataxia, diplopia, loss of one visual field, dysarthria. - Nursing: safe positioning, nothing by mouth until swallowing is assessed, frequent neuro checks and reporting any deterioration. ## Test yourself Think of the answer, then tap the question to see it. ## What does each letter of BE-FAST stand for? Balance, Eyes (vision), Face, Arm, Speech and Time (onset time and calling emergency services). ## Why is glucose checked in every patient with suspected stroke? Hypoglycaemia can cause focal deficits and confusion that mimic a stroke, and it is quickly corrected. ## What is the range of the NIHSS and what does a high score mean? It runs from 0 to 42; a higher score means a more severe stroke. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/clinical-exam/recognising-a-stroke-be-fast-and-the-nih-stroke-scale/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Middle cerebral artery](https://durgical.com/en/anatomy/middle-cerebral-artery/) - [Anterior cerebral artery](https://durgical.com/en/anatomy/anterior-cerebral-artery/) - [Posterior cerebral artery](https://durgical.com/en/anatomy/posterior-cerebral-artery/) - [Cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/) - [Motor cortex](https://durgical.com/en/anatomy/precentral-gyrus/) ## Related - [Pronator drift](https://durgical.com/en/clinical-exam/pronator-drift/) - [Cranial nerve examination](https://durgical.com/en/clinical-exam/cranial-nerve-examination/) - [Mental status: orientation, attention and screening tests](https://durgical.com/en/clinical-exam/mental-status-orientation-attention-and-screening-tests/) - [Upper vs lower motor neuron syndrome](https://durgical.com/en/clinical-exam/upper-vs-lower-motor-neuron-syndrome/) - [The neurological examination: order and screening exam](https://durgical.com/en/clinical-exam/the-neurological-examination-order-and-screening-exam/) ## Related conditions - [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/) - [Intracerebral haemorrhage](https://durgical.com/en/conditions/intracerebral-haemorrhage/) - [Transient ischaemic attack](https://durgical.com/en/conditions/transient-ischaemic-attack/) - [Subarachnoid haemorrhage](https://durgical.com/en/conditions/subarachnoid-haemorrhage/) - [Hypoglycaemia (including insulin-induced)](https://durgical.com/en/conditions/hypoglycaemia/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis. Sources: [Signs and Symptoms of Stroke](https://www.cdc.gov/stroke/signs-symptoms/index.html) (Centers for Disease Control and Prevention (CDC), 2024); [16.1 Overview of the Neurological Exam](https://openstax.org/books/anatomy-and-physiology-2e/pages/16-1-overview-of-the-neurological-exam) (OpenStax, Anatomy and Physiology 2e, 2022); [26.2 Physical Assessment - Clinical Nursing Skills](https://openstax.org/books/clinical-nursing-skills/pages/26-2-physical-assessment) (OpenStax, 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/recognising-a-stroke-be-fast-and-the-nih-stroke-scale/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/recognising-a-stroke-be-fast-and-the-nih-stroke-scale/