Stroke

Table of Contents

Stroke is a medical condition when part of the brain reduces its blood supply or even loses it completely. When a stroke occurs, brain cells (neurons) slowly die from a lack of oxygen and nutrient supplies from the blood, which can cause partial paralysis, memory loss, and even death.

A stroke can occur anytime and affect anyone. Some patients manage to fully recover from stroke, while others recover with paralysis.

About 80% of strokes occur because the artery in the brain becomes blocked (ischemic).  The remaining 20% are due to hemorrhagic ruptures. There is also such a thing as a mini stroke or transient ischemic attack (TIA). The symptoms of a TIA are similar to a stroke, but it only lasts a few minutes. In TIA, the blood vessels are temporarily blocked. Patients who have had a mini stroke run a greater risk to develop a stroke.

Ischemic Stroke

The blocked artery is caused by the buildup of fat or plaque on the artery walls. Fatty deposits that gradually build up from all the unhealthy food you consume or because of stress, eventually  clog the blood flow. 

Hemorrhagic Stroke

About 20% of strokes are caused by the rupture or tearing of blood vessels in the brain. This generally affects people suffering from high blood pressure. Hemorrhagic strokes fall into two category types:

Intracerebral Hemorrhage Stroke

Intracerebral hemorrhage is when a blood vessel in the brain bursts and causes bleeding. This rupture of blood vessels causes the neurons to gradually die.

Subarachnoid Hemorrhage Stroke

Meanwhile, subarachnoid hemorrhage is when a blood vessel bursts and blood floods the area between the brain and skull (called the subarachnoid). When this happens, you might experience sudden extreme dizziness.

When to See a Doctor for Stroke? 

Diagnosis

When seeking treatment for the first time, a neurologist will perform several tests to identify the type and area of ​​the patient’s brain affected by a stroke:

  • Blood test to measure cholesterol and blood sugar levels
  • Check the pulse to determine if it is regular or irregular
  • Measure blood pressure

Other additional tests may include: 

Magnetic Resonance imaging (MRI)

The MRI machine is used to look inside the patient’s brain. With the machine, a neurologist can identify the part of a blood vessel that is blocked or ruptured in the brain.

Computer Tomography (CT) Scan

CT scan has the same functions as an MRI. However, the images are not as detailed as the MRI results. Doctors use CT scans to identify damaged blood vessels.

Carotid Artery Ultrasound

The ultrasound device uses sound waves to observe the narrowing of blood vessels in a more detailed manner.

Cerebral Angiography

This test procedure helps doctors map the network of the brain’s blood vessels. The procedure is done by inserting a flexible tube (catheter) into the pulse and spraying a dye as a tool to photograph the blood flow.

Echocardiogram

Similar to an ultrasound, an echocardiogram makes use of sound waves to get a good look of organs in the body. This test helps doctors identify the source of blocked blood vessels by tracing the blood flow from the heart to the brain.

Second Opinion

Smarter Health can help you find a suitable neurologist in Malaysia or Singapore for a second opinion, check on your selected neurologist’s schedule and book an appointment, as well as calculate the cost of consultation or treatment.

Symptoms of Stroke

In the medical world, the symptoms of stroke are abbreviated as F.A.S.T: 

  • Face – one side of the face droops, you cannot smile 
  • Arms – cannot raise both hands
  • Speech – unable to speak clearly 
  • Time – it is time to go to the hospital

Even if the symptoms of a stroke last for a few minutes or less than a day, you should seek immediate care at a nearby hospital. A mini stroke symptom can lead to a future stroke at any time. 

Other common symptoms of stroke include:

  • Fainting
  • Partial paralysis 
  • Loss of balance
  • Sudden vision loss
  • Sudden, severe dizziness
  • Hearing difficulties
  • Difficulty speaking
  • Difficulty swallowing or drinking water

Treatment for Stroke

It is strongly advised to seek immediate intensive treatment as soon as you have symptoms of a stroke. The sooner you get treatment, the greater your chance of recovery. The phrase “time is brain” emphasises the importance of prompt stroke management. 

Treatment for stroke will be based on the type of stroke experienced:

Treatment for Ischemic Stroke

Ischemic stroke is when the blood vessels become narrowed. The following are some of the most commonly prescribed medications for ischemic strokes: 

Alteplase/thrombolysis

Alteplase is given through injection to remove the blockages in the blood vessels. This method is also known as thrombolysis. This treatment is recommended for patients who have shown symptoms for less than 4 hours.

Thrombectomy

The thrombectomy treatment method is performed by inserting a device (catheter) into the blocked artery, where the fat / plaque is destroyed or suctioned with the device. 

Antiplatelets

Antiplatelet medicines prevent blood cells from clotting; resulting in an obstruction. Antiplatelets include aspirin, clopidogrel and dipyridamole.

Anticoagulants

Anticoagulants may be given to stroke patients with irregular heartbeat. Similar to antiplatelets, these drugs also prevent blood clots. Anticoagulant medications include dabigatran, warfarin, edoxaban apixaban, rivaroxaban and heparins.

Antihypertensive Drugs

If the patient has a high blood pressure, doctors will generally prescribe medications that include angiotensin-converting enzyme (ACE) inhibitors, thiazide diuretics, calcium channel blockers, beta-blockers or alpha-blockers.

Statins

Statins will be prescribed if the patient has a high cholesterol. Statins help limit the enzymes in the stomach that trigger cholesterol. Statins are also recommended for non-stroke patients to reduce the risk of stroke.

Carotid endarterectomy

Carotid endarterectomy is a surgical procedure to remove fatty deposits / plaque from the arteries in the head or neck area.

Treatment for Hemorrhagic Stroke

Hemorrhagic stroke is when high blood pressure tears the walls of blood vessels in the brain. The doctor will execute a medical procedure to reduce bleeding in the brain through the following methods: 

Craniotomy

Craniotomy is a procedure that involves opening the skullcap, then closing the torn blood vessels, and ensuring there are no blood clots.

Surgery for Hydrocephalus

Stroke with hydrocephalus complication can be treated surgically. The doctor will add a tube (shunt) in the brain for the fluid buildup to flow to other parts of the brain.

Treatment Cost for Stroke

The treatment cost for stroke is often determined after the doctor knows the patient’s condition. Smarter Health can help you find specialist doctors and hospitals within your treatment budget.

Prevention of Stroke

Age, lifestyle and family history are factors that increase the risk of stroke. The following are some preventive measures that you can take to reduce the risk of stroke: 

Diet

You are recommended to consume low-fat and fibre-rich food sources such as fruits and vegetables. These foods can help prevent strokes effectively. Avoid fast food and anything high in sodium. An unhealthy diet can actually increase blood pressure, causing a stroke.

Physical Exercises

Ideally, a healthy diet is balanced with exercise and adequate sleep. Exercising for more than 30 minutes a day is the most effective way to control blood pressure and cholesterol levels in your body. If you cannot do the 30-min daily exercise session, aerobic exercise such as cycling or sprinting for 2 hours every week can be an alternative for you. 

Quit Smoking

Smoking not only increases the risk of stroke, but also lung cancer and heart attacks. Seek support from your family or close friends to help you quit smoking. If necessary, reach out to smoking cessation counselling services in health centers and hospitals.

Reduce Alcohol Consumption 

Excessive amounts of alcohol can increase blood pressure and trigger irregular heartbeat. Drinking too much alcohol can increase the risk of stroke by three times.

Get Routine Medical Check Ups

Doctors will recommend medical check ups once a year, especially if you are over 30. Medical check-ups are useful for detecting disease early, thus giving you more time to fight off a disease. The cost for medical check up varies and can be adjusted according to your budget.

Treatments for Patients Diagnosed with Stroke

In general, stroke patients will experience partial paralysis. 

If a stroke attacks the right side of the brain, then your left side of the body is paralysed, and vice versa. Some patients may not be completely paralysed – rather they have difficulty seeing, breathing, swallowing or drinking, and dealing with loss of balance.

After being treated in emergency care, stroke patients need to enter a rehabilitation program; with a focus on restoring motor functions, both psychologically and cognitively.

Psychologically, stroke patients might experience depression and anxiety. For some patients, taking medications as prescribed and getting therapy from a psychologist can help reduce the psychological impact.

To restore motor functions after a stroke, patients are usually advised to undergo physiotherapy. You can get this therapy in a hospital, health center or even at home. Family members are advised to accompany the patient throughout the therapy.  

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