The Singapore National Stroke Association (SNSA) reports stroke to be the fourth most common cause of death and the biggest source of long-term disability in the country. Each year, approximately 10,400 sufferers are admitted to Singapore hospitals.
A stroke occurs when the blood supply to a part of the brain is cut off or severely reduced, depriving it of oxygen and nutrients. Blood flow to the brain can be hampered in two ways: if a clot forms in a blood vessel (this results in an ischaemic stroke and accounts for almost 80 per cent of all cases) or if a blood vessel ruptures, causing blood to leak into the brain (which is a haemorrhagic stroke).
SIGNS AND SYMPTOMS
The symptoms one experiences depend on which part of the brain has been affected.
Check for the following signs:
• Stumbling, sudden dizziness, loss of balance or coordination.
• Slurred speech or loss of words to explain what is happening (aphasia). Try to repeat a simple sentence. If you can’t, you may be having a stroke.
• Paralysis or numbness on one side of the body. Try to raise both your arms over your head at the same time. If one arm begins to fall, it may signify a stroke attack.
• Sudden blurring, blackened vision or double vision.
• Sudden and severe headaches or an unusual headache which may be accompanied by a stiff neck, facial pain or pain between your eyes, and vomiting or altered consciousness.
If you notice a sudden onset of one or more of the above symptoms, call 995 immediately. A stroke is a true medical emergency and the outcome depends on how soon the appropriate treatment is started. Every moment is precious and can help minimise brain damage.
For a speedy diagnosis, remember the acronym FAST: Face, Arms, Speech and Time.
Face – Does one side of the face droop when asked to smile?
Arms – When raising both arms, does one arm drift downwards?
Speech – When trying to repeat a simple sentence, are the words slurred or incorrect?
Time – Rush to emergency care for evaluation and treatment.
On the way to the hospital, watch the person carefully. You may need to do the following:
1. If the person stops breathing, begin mouth-to-mouth resuscitation.
2. If vomiting occurs, turn the person’s head to the side to prevent choking.
3. Don’t let the person eat or drink anything.
STROKE WARNING
Stroke comes without warning in most people, but one possible indication is a transient ischaemic attack (TIA). A TIA is a temporary interruption of blood flow to one part of the brain, causing symptoms similar to that of a stroke but lasting for a few minutes to 24 hours after which they disappear without any permanent effects. You may have more than one TIA and the recurrent signs and symptoms may be similar or different. A TIA may indicate you’re at risk of a full-blown stroke in future.
RISK FACTORS
Several factors can increase the risk of developing a stroke. (Some of these overlap with the risk factors for a heart attack.)
• Family history of stroke, heart attack or TIA
• If you’re aged 55 or older
• High blood pressure – a systolic blood pressure of 140 mmHg or higher, or a diastolic pressure of 90 mmHg or higher
• High cholesterol – a total cholesterol level of 200mg per decilitre (mg/dL)
• Smoking
• Diabetes
• Obesity – a body mass index of 30 or higher
• Cardiovascular disease, including heart failure, a valvular defect, heart infection or abnormal heart rhythm
• Previous stroke or TIA
• High levels of homocysteine (an amino acid) in your blood
• Use of birth control pills or other hormone therapy in women
MODES OF TREATMENT
Getting prompt medical treatment for stroke is vital. To treat an ischaemic stroke, doctors must quickly restore blood flow to the brain. Clot-busting medicines such as aspirin or heparin, clot dissolving drugs or surgical procedures will be employed to remove the clot from the vessel. Surgery is usually employed in the case of a haemorrhagic stroke.
STROKE RECOVERY AND REHABILITATION
Rehabilitation of stroke patients is an important aspect that follows medical treatment. Recovery and rehabilitation depend on the area of the brain involved and the amount of tissue damaged. Damaged brain cells in the right half of the brain may affect movement and sensation on the left side of the body. Damage to brain tissue on the left side may affect movement on the right side; this damage may also cause speech and language disorders. In addition, people who have had a stroke may have problems with breathing, swallowing, balancing and hearing, vision and bladder or bowel function.
The goal of rehabilitation is to help a stroke victim become independent once again by re-learning the skills that may have been lost, such as movement or speech.
STROKE-PROOF YOUR LIFE
Identifying risk factors and rectifying them early will go a long way in preventing strokes.
1. Keep blood pressure in check by maintaining normal weight, proper diet and exercise, a low-sodium diet, moderate alcohol intake and managing your stress effectively. In case medication is required to control your BP, then regular follow-ups with the physician and regular consumption of your medicine are a must.
2. Cholesterol levels are another indicator. If you’re on the higher side, a diet low in saturated fats and high in fibre such as vegetables, fruits and pulses is ideal. If the levels are still not satisfactory, your doctor can prescribe cholesterol-lowering medication.
3. Diabetes increases the risk of strokes as well as heart disease. Keeping sugar levels in control by diet, exercise and medication along with regular monitoring of glucose levels is of utmost importance.
4. While drinking small amounts of alcohol can increase good cholesterol, binge drinking or increased consumption increases the risk of high BP and stroke. Keeping alcohol consumption to a minimum or nil puts you in a better position to avoid strokes.
5. Abusing drugs and substances has been known to cause TIAs and strokes, and other vicious side effects.
Stroke is preventable to some extent and reversible to a large extent. Studies suggest that up to a third of the patients recover fully, a third recover partially and a third do not recover at all. About 10 to 20 per cent die shortly after suffering a stroke. Recovery is a slow process taking anywhere from three to six months to nearly two years. With the support of family and society, more victims will be able to resume an active everyday life and responsibilities.
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