Many people don’t realize they’re having a stroke when it happens to them, says research from the University of Oxford. The new study highlights the importance of getting to the hospital quickly after a stroke, and points out an important symptom—vision loss—that’s often overlooked in public health campaigns.

The research, published in the British Journal of Surgery, involved 150 people who’d had a transient ischemic attack, also known as a mini-stroke, confirmed by a doctor. When questioned afterward, though, 59 percent of the study participants said they didn’t know they were having a stroke at the time.

And despite the “Act FAST” public health campaign that had been launched in the United Kingdom five years earlier, 36 percent of people weren’t familiar with the campaign’s message about stroke symptoms and the importance of seeking urgent medical care.

The FAST acronym—which stands for Face, Arm, Speech, Time—has been touted by experts in both the United Kingdom and the United States as a way to remember important symptoms of stroke and the response that should be taken. According to the American Stroke Association, symptoms of stroke include face drooping, arm weakness, and speech difficulties. And because time is of the essence, anyone with symptoms should get to a hospital right away. (Some drug treatments only help for a few hours after a stroke, and getting care right away can often prevent long-term effects or even death.)

Unfortunately, that wasn’t the case for most of these study participants. More than 61 percent did not seek immediate help when their mini-strokes occurred. Instead of going to the hospital, some called their doctors or other health professionals. Others phoned a family member, had a “cup of tea” and waited until the next day, or did nothing at all.

These delays lasted, on average, two to five days, although one patient wasn’t diagnosed for about four months. Patients’ reasons included being away on vacation, awaiting doctor’s appointments, and hospital hold-ups—but the biggest excuse, by far, was that they hadn’t recognized their symptoms. Some men also refused to admit that they were having a stroke, even when their instincts told them so.  

The study authors noted that nearly a third of participants reported a reduction or loss of vision during their episodes—something that’s not always considered an obvious sign of stroke. For about 20 percent of participants, in fact, vision problems were the only symptom. Of that group, not a single person was aware they were having a stroke.

Vision symptoms should be included in patient education and efforts to raise awareness about stroke, the authors say, and people should be reminded—again—about the need for a quick response.

“This study has highlighted the importance of patient recognition of cerebrovascular symptoms and acting on these rapidly,” they wrote. “A stroke campaign with inclusion of eye symptoms and rapid action may be more appropriate; hence FASTER (Face, Arm, Speech, Time, Eyes, React) may be better.”

 

This article originally appeared on RealSimple.com.