Chronic Conditions

Stroke

Understanding Stroke

A stroke occurs when a part of the brain is damaged due to a lack of blood supply. In minor strokes, the damage occurs only at a small portion of the brain. In major strokes, a large part of the brain is damaged. As a result of the damage, part of the body which is controlled by the damaged part of the brain will not function normally. Unlike other cells in the body, brain cells that die from stroke are unable to produce new cells.

Symptoms

When the brain cells are damaged, the following may be experienced:

  • Weakness or numbness of one side of the body
  • Slurred speech, difficulty in speaking
  • Loss of vision, experiencing double vision
  • Unsteadiness in walking, uncoordinated movements
  • Giddiness combined with one of the above symptoms
  • Headaches
  • Loss of consciousness, coma

You should seek urgent medical attention if you experience any of the above symptoms.

Causes

Lack of blood supply to a part of the brain is usually caused by a blockage of a blood vessel called ‘artery’ in the brain. Such a blockage results in an “ischaemic stroke”. In a less common situation, the lack of blood supply is due to an artery burst, resulting in a “haemorrhagic stroke”. A haemorrhagic stroke can be due to the rupture of a blood vessel which has ballooned because of weak walls (aneursym), or an arteriovenous malformation (AVM) which is an abnormality in the structure of the blood vessels.

Are you at risk?

The risks of getting a stroke are higher in people who fall under the below categories:

  • 40 years old and above (although younger people are at risk of getting stroke too)
  • Male
  • History of high blood pressure
  • History of diabetes
  • History of high cholesterol
  • History of irregular heartbeat
  • Smoking
  • Excessive alcohol use
  • History of previous stroke or transient ischemic attack (TIA)
  • Hormonal changes with pregnancy, childbirth, and menopause are also linked to an increased risk of stroke

You can reduce your risk of getting stroke, by visiting a doctor at least once a year for a medical check-up if you are over the age of 40 and consume all prescribed medications.

Diagnosis

If you experience signs and symptoms of stroke such as weakness or numbness of the limbs, you will need to undergo some tests which may include:

  • Blood tests To detect e.g. diabetes and high blood cholesterol
  • Brain scan Usually a CT or MRI scan to confirm the type of stroke (whether it is due to a blood clot or burst blood vessel) and where it has occurred
  • ECG (electrocardiogram) To look for heart disease
  • Ultrasound scans To look for abnormalities, e.g. of the blood vessels to the brain
  • Angiogram An x-ray test in which a small tube is inserted via a blood vessel in the groin to reach the blood vessel to the brain. A dye injected through the tube then shows the degree of blockage of blood vessels or the location of the bleeding in the brain

Treatment

  • Monitoring While in the hospital, your condition will be closely monitored as about 20% of patients get worse in the next few hours or days after the onset of the stroke. Very high blood pressure, blood sugar and cholesterol will need to be lowered by dietary control and even medication. Patients who are unable to swallow food and water safely may need to be fed through a tube through the nose.
  • Rehabilitation Rehabilitation is a process that aims to get you to be independent in your daily activities. This begins as soon as possible, through physical, occupational and speech therapy.
  • Medication In ischaemic stroke, the use of “blood thinners” such as “anti-platelet” and "anti-coagulant" medications helps to reduce the risk of a stroke occurring again.
  • Surgery If there is severe narrowing in a neck artery leading to a minor stroke or “transient ischaemic attack” (TIA), surgery to remove the narrowing (carotid endarterectomy) will reduce the risk of another stroke.

Prevention

While you may not be able to control some risk factors, such as ageing, family health history, race and gender; you are able to lower your risk by:

  • Early detection and treatment of high blood pressure
  • Early detection and treatment of diabetes
  • Early detection and treatment of high blood cholesterol
  • Taking prescribed medication for previous stroke or TIA
  • Quitting smoking
  • Maintaining a healthy weight range, keeping your BMI at 18.5-22.9kg/m2s
  • Having a healthy diet, which is low in fat, salt and sugar and high in fibre. Consume at least 2 servings each of fruits and vegetables daily.
  • Exercise for 30 minutes at least 5 days a week. If you have not been exercising regularly, check with your doctor before you start an exercise programme.
  • Limiting alcohol intake to no more than 2 standard drinks per day:
    • 2/3 small can of beer (220ml),
    • 1 glass of wine (100ml),
    • 1 nip of spirit (30ml)
  • Managing your stress
  • Going for regular check-ups

Resources

Find out more information from:

Health Promotion Board

Singapore National Stroke Association


  1. What is a Stroke?
A stroke occurs when a part of the brain gets damaged by a lack of blood supply. The signs and symptoms of stroke depend on the size and location on the part of the brain that is damaged. A “transient ischaemic attack” (TIA) or “mini-stroke” is where the symptoms of stroke last a short time and disappear completely within 24 hours.
  2. How do I know if a person has stroke?
It is important to recognise the signs of stroke. The FAST test is an easy way to recognise and remember the most common signs of stroke. FAST stands for: Facial weakness – Can the person smile? Is his/her eye or mouth drooping? Arm weakness – Can the person raise both arms? Speech difficulty – Can the person speak clearly and understand what you say? Time to act fast – Go to the nearest Emergency Department IMMEDIATELY. Other symptoms are difficulty in swallowing, dizziness, severe headache (“worst headache ever had”), confusion and numbness.
  3. What are the risk factors for stroke?

Controllable risk factors:

Uncontrollable risk factors:

  • Family history
  • Age
  • Gender
  • Race
  4. What are the chances of recovery?
Recovering from a stroke is a natural process. Studies show that up to a third of stroke patients recover fully, one third recover partially, and the other one third do not recover at all. About 10% to 20% die soon after a stroke. While there are no medications to cure a stroke, a lot can be done to reduce the resulting disabilities and the chances of the stroke happening again. Recovery takes time – most occur in the first 3 to 6 months, but it may continue for up to 2 years or more. So, do not lose hope if the stroke seems to be very severe in the beginning. Persist with your rehabilitation under the supervision of your doctor.
  5. Can stroke be prevented?

Several steps can be taken to reduce your risk of stroke:

  • Eat a healthy diet
  • Maintain a healthy weight
  • Be active physically
  • Stop smoking
  • Limit alcohol consumption
  • Early detection or treat high blood pressure
  • Early detection or treat high blood cholesterol
  • Early detection or treat diabetes
  • Take your medications regularly as prescribed by your doctor