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Stroke

  • What is a Stroke?

    Stroke, Gleneagles Hospital

    Stroke is the 3rd leading cause of death in Singapore, accounting for about 7% of all deaths annually in 2015.1 It occurs when blood supply to part of the brain is suddenly disrupted or severely reduced, resulting in the death of brain cells. A stroke may cause permanent injury or disability, depending on the part of brain affected.

    There are 2 main causes of stroke:

    • Ischaemic Strokes occur when the artery supplying blood to the brain becomes blocked due to a build-up of cholesterol deposits (plaque) within the artery wall, or by a clot that comes from the heart or up-stream from the same blood vessel.
    • Haemorrhagic Strokes occur when a weakened blood vessel in the brain bursts. This is usually due to high blood pressure. However, two other types of weakened blood vessels typically cause haemorrhagic stroke – an aneurysm which is the ballooning of a weakened region of a blood vessel, or an arteriovenous malformation (AVM) which is a cluster of abnormally formed blood vessels in the brain.

    In a transient ischaemic attack (TIA), the blood supply to the brain is temporarily interrupted due to a transient blood clot which naturally dissolves after a while. This causes a ‘mini-stroke’ with symptoms occurring rapidly and lasting for a relatively short time (minutes to less than 24 hours). People who experience TIA should regard this as a serious warning sign and seek immediate medical assistance to understand their risk factors and potentially prevent the occurrence of stroke.

    Stroke is often thought of as a disease that affects the elderly. However, the fact is that a stroke can strike anyone at any age. Learn the truth behind some of the most common myths about stroke.

  • A stroke is a singular, damaging event, but the conditions leading to a stroke often develops over time. It is important to be aware of the risk factors associated with stroke and to take preventive measures where possible.

    People with the following conditions are at higher risk of suffering from stroke:

    • High blood pressure (hypertension)
    • Heart disease
    • Diabetes
    • Cigarette smoking
    • Heavy alcohol consumption
    • High blood cholesterol level

    These are risk factors that can be modified by lifestyle change and medication.

    Certain risk factors cannot be changed. They include:

    • Increasing age
    • Previous stroke or TIA
    • A family history of stroke
    • Uncommon genetic or congenital conditions.

    With certain lifestyle changes, selected risk factors such as high blood pressure and cholesterol levels can be managed. Speak to your doctor to understand more.

  • Symptoms of stroke commonly involve the following:

    • Sudden weakness and/or numbness on one side of the body
    • Sudden double vision or other visual disturbances
    • Sudden confusion or dizziness
    • Sudden severe headache
    • Sudden sensitivity to light
    • Difficulty in speech or swallowing
    • Loss of balance or coordination
    • Loss of consciousness
    • Loss of memory or concentration
    • Feeling of nausea or light vomiting

    If you experience any of the above warning signs, it is important to seek medical attention promptly. Immediate medical treatment (within 3 hours of stroke onset) can substantially reduce any potential disability. Talk to your doctor to find out more.

  • Methods of stroke prevention and treatment include:

    • Blood thinners (eg. aspirin) to assist with blood flow and to reduce the risk of a recurrent stroke
    • Medication or dietary changes to control blood pressure, cholesterol, or blood glucose levels
    • Rehabilitation treatment which may include individualised physiotherapy and/or speech therapy to help patients resume their daily activities
    • Surgical intervention if necessary to reduce the risk of stroke, such as endarterectomy surgery (CEA) to correct the narrowing of an artery

    Your doctor will evaluate your condition and recommend the treatment that suits you best.

    Primary prevention is to prevent stroke in people who are diagnosed with risk factors but have never experienced stroke before. For patients with high blood pressure, medications such as antihypertensive drugs may be prescribed. Studies have shown the benefits of high blood pressure treatment in elderly patients, where even small reductions in blood pressure can effectively reduce stroke risk by 30 – 40%.2 Patients with heart disease such as irregular heartbeat (atrial fibrillation) may be prescribed anticoagulants (blood thinners) to manage their condition and to reduce stroke risk.

    Secondary prevention means reducing the chance of a stroke reoccurring after a stroke or TIA has already occurred. The risk of a stroke reoccurring after a stroke or TIA is 5 – 15% annually.3 Prescription of medication in the form of antiplatelet drugs that reduce the tendency of blood to clot, or cholesterol-lowering medication, may reduce the risk of subsequent stroke by up to five-fold over a 90–day period.4 Depending on severity of cases, surgical intervention may be necessary.

    By understanding the risk factors and adjusting your lifestyle, you can reduce your chances of getting a stroke. Take charge of your health today by applying the following general guidelines:

    • Stop smoking
    • Limit alcohol intake
    • Exercise moderately
    • Eat healthy with a diet low in salt, sugar and refined carbohydrates (e.g. white bread and noodles), complemented by fruits and vegetables
    • Go for regular checkups to understand your risk factors ie. cholesterol, blood glucose levels, heart health, and whether you have disordered breathing in sleep (sleep apnoea) which leads to increased blood pressure
    • Seek medical treatment if blood pressure is diagnosed as more than 140/90mmHg across 3 separate measurements

    Talk to your doctor to find out more. Learn more about stroke prevention and the screening options available

  • If you have risk factors associated with stroke, it is important to talk to your doctor and find out if there are suitable screenings you can undergo to manage your risk of getting a stroke.

    These are general steps you should take in order to better understand and reduce your risk:

    • Check your blood pressure and get it treated if it is high. High blood pressure, or hypertension, is defined as having a BP of more than 140/90mmHg on 3 separate occasions. Hypertension increases stroke risk up to 6 times.
    • Find out if you have diabetes. Diabetes quadruples the risk of stroke, and raised blood sugar worsens recovery when a stroke occurs.
    • Check your cholesterol level and take steps to lower it if it is high. A raised cholesterol may increase stroke risk up to 3 times.
    • Find out if you have heart disease. Atrial fibrillation (irregular heartbeat), in particular, can increase stroke risk by 4 – 6 times. In this condition, blood in the heart tends to form clots that can travel to any part of your body. If they travel to the brain, these clots can cause a stroke.
    • Find out if you have carotid artery disease. The carotids are the vessels that carry most of the blood supply to the brain, and an operation can be done to clear them of deposits if they are severely narrowed.
    • Find out if you have disordered breathing in sleep (sleep apnoea). Sleep apnoea is almost always found in people who snore when asleep. It can lead to increased blood pressure, which in turn predisposes to stroke and heart attack. People with sleep apnoea develop dangerously low levels of oxygen in the blood while carbon dioxide levels rise, possibly causing strokes in sleep.
  • Although stroke is the 3rd leading cause of death in Singapore, many myths surround this condition. Knowing the facts can help you respond appropriately and promptly during the event of a stroke.

    MYTH: Strokes only happen to older people

    FACT: Strokes can strike any one at any age. While it is true that the risk of stroke increases with age, it is dangerous to think that a stroke cannot happen to a young person, and to ignore the symptoms when they occur. It is also important to note risk factors such as high blood pressure and obesity, and to make the necessary lifestyle changes such as exercising well and eating right.

    MYTH: Strokes occur in the heart

    FACT: Strokes occur in the brain. A stroke happens when blood supply to part of the brain via the blood vessels (arteries) is suddenly disrupted or severely reduced, leading to deprivation of oxygen and nutrients in the brain tissue. This causes the death of brain cells and may result in permanent injury or disability, depending on the part of brain affected.

    Myth: Small strokes do not need medical attention

    FACT: Every stroke, no matter how minor, requires immediate medical attention. Some people may experience a transient ischaemic attack (TIA), where the blood supply to the brain is temporarily interrupted due to a transient blood clot. This causes a ‘mini-stroke’ with symptoms occurring rapidly and lasting for a relatively short time. People who experience TIA should regard this as a serious warning sign and seek immediate medical assistance to prevent the occurrence of a subsequent major stroke.

    MYTH: Strokes never happen in infants

    FACT: Stroke can strike anyone, including infants. In younger patients, stroke may occur due to congenital heart disease or due to autoimmune disease where the syndrome results in blood clotting irregularities.

    MYTH: Severe headache is a sign of a stroke

    FACT: A headache can be due to many reasons and is usually not a sign of a stroke. However, some strokes may result in sudden severe headaches. A stroke severe enough to cause a headache will always be large enough to cause other stroke symptoms. Headaches due to a sudden bleed are severe and are accompanied by symptoms such as nausea, light vomiting and sudden light sensitivity.

    MYTH: Strokes cannot be prevented

    FACT: Many of the risk factors for stroke can be affected by lifestyle change or medication. Managing your high blood pressure, high blood cholesterol levels, heart disease and diabetes are all ways to reduce your chances of having a stroke. Other preventive measures include not smoking, limiting alcohol consumption and controlling your weight.

    Information contributed by Dr Ho King Hee, Neurologist, Gleneagles Hospital.

    References

    1. Ministry of Health, Principal Causes of Death, Retrieved 2016 https://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Principal_Causes_of_Death.html
    2. BMJ. 1992 Feb 15; 304(6824): 405–412. Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party
    3. Cillessen JP, Kappelle LJ, van Sweiten JC, Algra A, van Gijn J. Does cerebral infarction after a previous warning occur in the same vascular territory. Stroke 1993;24:351-4, Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA 2000;284:2901-6
    4. Rothwell PM, Giles MF, Chandratheva A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 2007;370(9596):1432-42
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