Recognizing a Stroke - Three Commands for the Victim

Medical Author: Melissa Conrad Stoppler, MD
Medical Editor: Jay W. Marks, MD

Three commands sometimes used by doctors to begin assessing whether a person may be experiencing a stroke can also be useful for people who are not doctors, according to a study by University of North Carolina researchers.

Lay persons can command a potential stroke victim to:

1. Smile.
2. Raise both arms.
3. Speak a simple sentence.

The three commands, known as the Cincinnati Prehospital Stroke Scale (CPSS), are used by health professionals as a simple first step in the assessment process for signs of stroke. If a person has trouble with any of these simple commands, emergency services (911) should be called immediately with a description of the situation, noting that you suspect the individual is having a stroke.

A stroke results from impaired oxygen delivery to brain cells via the bloodstream. According to the U.S. National Institute of Neurological Disorders and Stroke, the five major signs of stroke are the sudden onset of:

1. Numbness or weakness of the face, arm or leg, especially on one side of the body. The loss of voluntary movement and/or sensation may be complete or partial. There may also be an associated tingling sensation in the affected area.
2. Confusion, trouble speaking or understanding. Sometimes weakness in the muscles of the face can cause drooling.
3. Trouble seeing in one or both eyes
4. Trouble walking, dizziness, loss of balance or coordination
5. Severe headache with no known cause

The physicians at UNC showed in a small study that lay persons can effectively recognize the signs of stroke using the CPSS assessment. While this study was funded by the American Stroke Association (ASA) and its results presented at their 2003 International Stroke Conference, the ASA has not taken an official position on recommending the use of the CPSS by lay persons due to the small size of the preliminary study.

In any case, should a person experience any of the signs of stroke or be unable to complete the three simple tasks, emergency services should be notified immediately. Both the death rate and level of disability resulting from strokes can be dramatically reduced by immediate and appropriate medical care.

For more, please read our Stroke article.

Reference: Liferidge AT, Brice JH, Overby BA, Evenson KR. Ability of laypersons to use the Cincinnati Prehospital Stroke Scale. Prehosp Emerg Care. 2004 Oct-Dec:8(4):384-7.