⚠ Posterior Circulation — FAST Can Miss This
Posterior fossa strokes (cerebellum, brainstem) often present with vertigo, vomiting, and ataxia alone — no facial droop, no arm weakness, no speech change. BE-FAST will be negative. Acute onset + no prior history + new or assumed new HTN = stroke pathway regardless of FAST result. Consider Wallenberg syndrome if vertigo is prominent.
A
Ataxia
Sudden loss of balance, coordination, or difficulty walking — compare to baseline
V
Vertigo
Severe acute dizziness or sensation of the room spinning — sudden onset
V
Vomiting
Sudden unexplained nausea or vomiting — especially with no GI history
V
Visual deficit
Sudden loss of vision, double vision, or visual field disturbance
Conveyance rationale: Acute onset · No prior history · Assumed new HTN · Previously fit and well · No alternative diagnosis that fits. A FAST-negative result does not require an alternative explanation — "acute, new, and unexplained" is sufficient grounds to convey and document posterior stroke concern. Document AVVV positives explicitly on the PRF.
Any positive = Pre-Alert as Stroke
State: suspected stroke, time of onset, BE-FAST positives, GCS, AVVV features if FAST negative
Do not delay on scene. Nearest HASU if FAST positive. ED with documented posterior concern if FAST negative.