Sudden facial droop, one weak arm or unclear speech means call 120 immediately; do not wait or drive yourself
Facial droop, inability to raise one arm or unclear speech calls for China's 120 immediately. In the cited analysis, clot-dissolving treatment within 3 hours produced odds of recovery to near independence about 1.75 times those without treatment; at 3–4.5 hours this fell to 1.26. Beyond 4.5 hours, the difference was not statistically clear. Record the exact onset time. Do not give water or medication, or drive yourself.
What it takes
Free. Learn three checks: ask for a smile, both arms raised and a complete sentence.
What you may gain
The source describes an individual-patient meta-analysis of 16 intravenous-thrombolysis randomized trials and 6,756 patients. Thrombolysis uses medicine to reopen a blocked vessel. Alteplase within 3 hours yielded an odds ratio of 1.75 for recovery to modified Rankin score 0–1, 95% CI 1.35–2.27. At 3–4.5 hours the odds ratio was 1.26 (1.05–1.51), and beyond 4.5 hours 1.15 (0.95–1.40), no longer statistically distinguishable. Confidence intervals describe uncertainty around the estimate.
Context & considerations
Earlier thrombolysis worked better in this analysis. The result beyond 4.5 hours was statistically inconclusive; it does not establish that all later stroke treatment is futile. Seek emergency assessment even if that interval has passed. Calling 120 rather than driving allows ambulance routing to a stroke-capable hospital and advance notification. Clinicians need the exact onset time to assess eligibility. Do not offer water or medication or wait to see whether rest helps.
Research & references
Emberson J, Lees KR, Lyden P, et al. (2014). Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet, 384(9958), 1929-1935. https://doi.org/10.1016/S0140-6736(14)60584-5