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Neurology Cerebrovascular Disease Beginner
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Acute Stroke Warning Signs: BE-FAST

B
E
-
F
A
S
T
Modern emergency public and clinical screening protocol for identifying acute ischemic and hemorrhagic strokes.

Expanding the traditional FAST tool to include Balance and Eyes (BE-FAST) captures up to 95% of posterior circulation ischemic strokes that might otherwise be missed.

Systematic Breakdown

B

Balance (Sudden Loss of Balance / Coordination)

Sudden ataxia, gait instability, or dizziness reflecting cerebellar or brainstem ischemia.

E

Eyes (Sudden Vision Loss / Diplopia)

Sudden amaurosis fugax, hemianopia, or diplopia (posterior cerebral artery or vertebral artery occlusion).

F

Face (Facial Drooping / Asymmetry)

Unilateral facial droop, flattened nasolabial fold (sparing the forehead in UMN stroke; whole face affected in Bell's palsy).

A

Arm (Arm / Leg Weakness or Drift)

Pronator drift or unilateral hemiparesis when both arms are extended with palms up and eyes closed for 10 seconds.

S

Speech (Slurred Speech / Aphasia)

Dysarthria (slurring) or expressive/receptive aphasia (inability to produce or comprehend language).

T

Time (Time to Call Emergency / 'Time is Brain')

Note exact time patient was 'last known normal' (LKN) to evaluate eligibility for IV thrombolysis (<4.5 hours) or mechanical thrombectomy (<24 hours).

High-Yield Clinical Pearls & Exam Tips
  • Forehead Sparing: UMN stroke spares the forehead due to bilateral cortical innervation of upper facial muscles; LMN facial nerve lesion (Bell's palsy) paralyzes the entire half of the face including forehead.
  • IV Thrombolysis (Alteplase/Tenecteplase) therapeutic window: within 4.5 hours of last known well time.
Related Pharmaceuticals
Tenecteplase Alteplase Aspirin
Related Clinical Conditions
Ischemic Stroke Transient Ischemic Attack Bell Palsy Intracerebral Hemorrhage
Authoritative Sources: AHA/ASA Guidelines for the Early Management of Acute Ischemic Stroke · First Aid USMLE Step 1

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System Notice

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