Sudden facial drooping, weakness in one arm, and slurred speech — call 120 immediately; don’t wait or drive yourself
Sudden facial drooping, weakness in one arm or unclear speech: any one of these is a reason to call 120 immediately. When a stroke can be treated with clot-dissolving medicine, earlier treatment gives a better chance of recovery. Do not give up emergency care after 4.5 hours or if onset time is unknown; doctors must assess eligibility. Record the onset time. Emergency personnel should take the patient to a hospital that can provide thrombolysis.
No cost at all. These three steps are easy to remember: as…
A meta-analysis pooled individual data from 9 randomized trials of intravenous thrombolysis involving 6756 pat…
No cost at all. These three steps are easy to remember: ask the person to smile, raise both arms straight out, and say a complete sentence.
A meta-analysis pooled individual data from 9 randomized trials of intravenous thrombolysis involving 6756 patients with acute ischemic stroke. Ischemic stroke is caused by a blocked blood vessel; intravenous thrombolysis uses medication to reopen it. The study assessed whether patients were free of significant disability 3–6 months later (modified Rankin score 0–1). For alteplase within 3 hours of onset, the odds ratio was 1.75, 95% CI 1.35–2.27 (confidence interval). The actual proportions were 32.9% with treatment and 23.1% in controls, a difference of 9.8 percentage points. An odds ratio is not a ratio of probabilities; this does not mean the probability of recovery was 1.75 times as high. At 3–4.5 hours the odds ratio was 1.26 (1.05–1.51). Beyond 4.5 hours it was 1.15 (0.95–1.40), with no statistically clear difference in this study. This does not mean treatment is impossible after 4.5 hours. The American Heart Association and American Stroke Association 2026 guidelines support extending the thrombolysis window for selected patients. Those with unknown onset or onset 4.5–9 hours earlier may still be eligible after specialized imaging selection. Doctors must assess eligibility; earlier medical care is better. The Chinese Stroke Association Emergency Medicine Branch’s 2017 prehospital consensus requires emergency personnel to transport suspected stroke patients as quickly as possible to the nearest certified stroke center or hospital capable of intravenous thrombolysis and/or endovascular treatment, and to notify the receiving hospital before arrival. It also notes that aspiration and other factors can impair breathing in acute stroke. The consensus recommends teaching the public the “Stroke 1-2-0” mnemonic: 1—look for an asymmetric face or drooping mouth; 2—raise both arms parallel and check for weakness on one side; 0—listen for unclear speech or difficulty expressing words. If any of these symptoms appears suddenly, call 120 immediately. When taking the history, emergency personnel should prioritize the time symptoms began.
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；中国卒中学会急救医学分会 (2017). 脑卒中院前急救专家共识. 中华急诊医学杂志, 26(10), 1107-1114. http://www.cem.org.cn/rhtml/20171002/index.htm；Prabhakaran S 等 (2026). 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke. Stroke. https://doi.org/10.1161/STR.0000000000000513；American Heart Association (2026). Top Things to Know: 2026 Guideline for the Early Management of Patients With AIS，第 3 点. https://professional.heart.org/en/science-news/2026-guideline-for-the-early-management-of-patients-with-acute-ischemic-stroke/top-things-to-know
Open source linkThrombolysis is more effective the earlier it is given, but do not abandon emergency care because more than 4.5 hours have passed. Call 120 instead of driving yourself: the prehospital consensus requires emergency personnel to take patients to a hospital that can provide thrombolysis and notify it in advance. Record the exact symptom-onset time so doctors can assess treatment opportunities. Giving no water or medicine is the author’s inference from the consensus warning about aspiration: a stroke patient may choke. Do not wait to “rest and see.” Site verification note: seek immediate medical care even beyond 4.5 hours; this time alone cannot show treatment is ineffective. The 2026 AHA/ASA guidelines support extended-window thrombolysis for selected patients with unknown onset or onset 4.5–9 hours earlier, screened using advanced imaging. The stroke team decides treatment. OR means odds ratio and cannot be read directly as a multiple of probability. AHA/ASA guidelines