Sudden severe vertigo, imbalance, double vision, one-eye blackout or poor coordination can also mean stroke
Face-arm-speech checks alone missed more than one in ten strokes in one study. Adding imbalance and visual problems reduced the missed proportion to 4.4%. Sudden spinning that prevents standing, double vision or inability to touch the nose accurately also warrants China's 120 and recording onset time.
What it takes
Free. Beyond face, arms and speech, ask about sudden imbalance, double vision or missing visual areas. Observe symptoms without making a dizzy person stand or close their eyes; call emergency services immediately for sudden suspected-stroke symptoms.
What you may gain
A University of Kentucky stroke-center review of 736 acute ischemic strokes in 2014 found that 14.1% had none of the FAST signs: facial weakness, arm weakness or speech difficulty. Including gait imbalance, leg weakness and visual symptoms reduced the missed proportion from 14.1% to 4.4%.
Context & considerations
Posterior-circulation strokes involving the cerebellum or brainstem may lack facial droop and arm paralysis. Vertigo, veering gait, double vision or choking on food/water can be mistaken for neck problems, low blood sugar or benign positional vertigo. Poor finger-to-nose coordination and inability to balance with eyes closed can indicate cerebellar involvement. No single maneuver rules out stroke: sudden persistent symptoms warrant 120 and a precise onset time. This was a single-hospital records review, and the authors called for further validation. Safety correction to the original: its suggested standing-with-eyes-closed test has been replaced with symptom observation and immediate emergency contact, consistent with NHS guidance recognizing sudden dizziness or falling as possible stroke symptoms.
Research & references
Aroor S, Singh R, Goldstein LB (2017). BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic. Stroke, 48(2), 479-481. https://doi.org/10.1161/STROKEAHA.116.015169; NHS. Symptoms of a stroke. https://www.nhs.uk/conditions/stroke/symptoms/