Around 100,000 people experience a stroke in the UK every year, equivalent to one stroke every five minutes. Yet not all strokes present with the symptoms many people have been taught to recognise. According to research, more than one-third (39%) of patients with MRI-confirmed minor stroke or transient ischaemic attack (TIA) initially present with symptoms that fall outside traditional stroke warning signs, which can increase the risk of delayed diagnosis and treatment.

On World Stroke Day (29 October), lawyers at Stewarts are highlighting the importance of recognising both typical and less familiar stroke symptoms following the case of client Wayne Burgess, whose stroke was not immediately identified despite repeated concerns from his wife that he could be having a stroke.

Many people are familiar with the FAST acronym, which helps identify some of the most common signs of stroke:

• Face – is the face drooping to one side or is it numb? Ask the person to smile. Is the person’s smile uneven?
• Arm – is there a weakness or numbness in one arm? Ask the person to raise both arms. Does one arm drift downward?
• Speech – is speech slurred or garbled? Ask the person to repeat a simple sentence such as “the sky is blue”. Is the person unable to speak or hard to understand?
• Time – if the person shows any of these symptoms, even if the symptoms go away, call the emergency services and get them to hospital immediately.

However, stroke symptoms can extend beyond those captured by FAST. To help improve recognition of a wider range of warning signs, some organisations now promote the BE FAST acronym:

• Balance – sudden loss of balance or coordination
• Eyes – sudden blurred vision, double vision or vision loss
• Face – facial weakness or drooping
• Arms – arm weakness or numbness
• Speech – slurred speech or difficulty speaking
• Time – seek urgent medical attention immediately.

Wayne’s experience demonstrates why recognising these additional symptoms can be so important.

Wayne’s story

Wayne, from Dover, suffered a posterior circulation stroke in July 2024. He experienced symptoms including sudden visual disturbance, dizziness, confusion and problems with his balance.

Despite his wife Lizzie, an experienced nurse, repeatedly raising concerns that he could be having a stroke, Wayne was initially assessed as FAST negative. There was then a six-hour delay before he received specialist stroke treatment and, by the time his stroke was formally diagnosed, he had fallen outside the treatment window for thrombolysis.

Wayne was left with permanent visual impairment, neurological symptoms and cognitive difficulties. He has been unable to return to work and was forced to give up his garden maintenance business.

At the time of Wayne’s stroke, East Kent did not have a local thrombectomy service. Although a service has since been introduced, availability of thrombectomy services continues to vary across the country, with some services unavailable at certain times or in certain areas. These inconsistencies can affect the treatment options available for patients experiencing a stroke.

See Wayne’s story featured on ITV News

Wayne and Lizzie shared their experience with ITV News as part of a report highlighting the rise in strokes among younger people and the importance of recognising stroke symptoms and accessing urgent treatment.

Recognising symptoms beyond FAST

Posterior circulation strokes occur when blood flow is interrupted to the back part of the brain. Unlike many strokes, they may not cause the facial weakness, arm weakness or speech difficulties typically associated with FAST.

Instead, patients may experience symptoms such as dizziness, loss of balance, visual disturbance, double vision, nausea, vertigo or confusion. These symptoms can be more difficult to recognise, despite requiring the same urgent medical attention as any other stroke.

Wayne’s lawyer, Nadia Krueger-Young, a partner in Stewarts’ Medical Negligence team, comments:

“Wayne’s case highlights two important patient safety issues. The first is recognising that stroke does not always present through the symptoms captured by traditional awareness campaigns. Posterior circulation strokes can present very differently and delays in diagnosis can have life-changing consequences.

“The second is the continued variation in access to specialist stroke services across the country. For some patients, treatment options can depend on where they happen to live and which services are available locally at the time they need them.

“We have seen significant improvements in stroke care in recent years, including the introduction of a thrombectomy service in East Kent, but concerns remain about consistency of access and ensuring that patients presenting with less typical symptoms are identified and assessed quickly enough to benefit from available treatments.

“Ultimately, improving outcomes requires both prompt recognition of stroke and equitable access to specialist services. Greater awareness of the full range of stroke symptoms could help more patients access potentially life-saving treatment when every minute counts.”

Marked annually on 29 October, World Stroke Day provides an important opportunity to raise awareness of stroke symptoms and the need for urgent treatment. While awareness campaigns have helped save countless lives, strokes occur every day of the year. Improving understanding of both typical and less well-known symptoms could help more people receive timely diagnosis and treatment, regardless of when or where a stroke occurs.

You can find out more about our experience supporting patients and families affected by delayed stroke diagnosis and treatment on our Medical Negligence pages.