Currently a story is going around on Facebook that there is a new stroke indicator:

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Now doctors say a bystander can recognize a stroke by asking three simple questions:

S = Ask the individual to SMILE.

T = Ask the person to TALK and SPEAK A SIMPLE SENTENCE (Coherently) (i.e. Chicken Soup)

R = Ask him or her to RAISE BOTH ARMS.

If he or she has trouble with ANY ONE of these tasks, call emergency number immediately and describe the symptoms to the dispatcher.

New Sign of a Stroke -------- Stick out Your Tongue

NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out his tongue. If the tongue is 'crooked', if it goes to one side or the other that is also an indication of a stroke.

The comments are of course plenty, anecdotal and opinionated.

Is there any documented proof that a crooked tongue is a reliable indicator?
That does not mean that it can't have false positives of course, anything that substantially increases the chance of spotting a stroke, is welcome.

One thing we do not need is another urban legend.

The story is posted on a "Doctors and hospital" Facebook page which contains sensible posts as well as blatant nonsense.


The reliability of a version of this test was examined in:

They didn't just look at stroke patients, but also Transient Ischemic Attack (TIA) patients - i.e. a "warning stroke", that may lead on to full strokes.

They used digital photography to precisely measure the tongue's deviation, and also had two physicians visually examine the tongues.

The two different physicians got different results, but they were promising:

With respect to the visual examination of physician “A,” 40% of stroke patients, 24% of TIA patients, and 4% of normal subjects were found to have tongue deviations. As for the visual examination by physician “B,” 32% of stroke patients, 16% of TIA patients, and 0% of normal subjects were found to have tongue deviations [5,16].

So, there are some false positives (tongue deviations in healthy patients) and a lot of false negatives (stroke and TIA patients without a deviation), but the results were promising in giving another sign to help a diagnosis.

Using the tongue deviation angle of 3.2° discussed above as the threshold value, 84% of TIA patients and 88% of stroke patients are considered to have obvious tongue deviations. The percentages are much higher than that in reference 5, and they are high enough to be an indicator of stroke.

However, these were using two physicians, with some experience at examining tongues (certainly by the conclusion of the experiment), and the size of the assymmetry was sometimes small. This isn't evidence that a First Aid responder could detect such a sign accurately.

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