Before the stroke strikes

A stroke is a devastating disease that is often debilitating or fatal. However, early treatment can minimise damage and potential complications. Dr Tang Kok Kee, neurosurgeon from Mount Elizabeth Hospital, shares with us the early signs of stroke and treatment for patients who are suffering from this deadly disease.

Stroke is a major cause of death and long-term disability in Singapore and other parts of the world. According to the World Health Organisation, stroke is the third leading cause of death in males, and fourth in females in Singapore. It accounts for approximately 7% of all deaths recorded for the year 2008. The disease also ranked second, causing 11% of deaths among the elderly aged 65 and above.

What is a stroke?

A stroke, or is a ‘brain attack’, is a condition where blood supply to the brain is interrupted or severely reduced, depriving the brain tissues of oxygen and food. Within minutes, this leads to brain cell death and brain damage, often resulting in impairment of speech, movement, and memory.

According to Dr Tang, there are two main types of stroke. A haemorrhagic stroke is caused by a burst blood vessel and accounts for about 12% of all strokes. The rest are ischaemic strokes, which occur when arteries to the brain are blocked or narrowed.

The outcome of a stroke depends on location of stroke, and how much of the brain is affected. Minor strokes may cause trifling problems such as weakness in the limbs, while major strokes can lead to paralysis or death.

Case Study: Blister in the Brain

Mr John Lim from Brunei recalls feeling an acute pain in his head and weakness in his legs before he passed out. He was rushed to the hospital in his hometown, and subsequently flown to Mount Elizabeth Hospital in Singapore within 24 hours.

A Computed Tomography (CT) scan of the brain confirmed the presence of an aneurysm, a blister-like bulge in the artery caused by weakening of the artery wall. John’s condition was known medically as subarachnoid haemorrhage, a type of haemorrhagic stroke where the aneurysm ruptures and causes blood to flow between the left and right hemispheres of the brain. The aneurysm was found at the bottom middle of the skull, at the organ that controls the limbs, thereby accounting for the weakness in his legs.

Dr Tang highlights that the blister is dangerous because it may rupture anytime and patients may lose consciousness. John was very lucky to recover after passing out, because the ruptured aneurysm had sealed up spontaneously by itself. If left untreated, the next bleed may be fatal. Even if he survives another attack, he may become vegetative.

Detecting stroke the FAST way

Stroke isn’t always a silent killer. Sometimes, there are early warning signs which can be picked up and acted upon. A Transient Ischaemic Attack (TIA) is a major indicator warrants a full check-up immediately. It has stroke-like symptoms, and one can verify it by following the F-A-S-T steps.

Facial symmetry
Smile, and if one side of the mouth is drooling, it is a strong sign of an impending stroke

Arms and legs
Lift both arms, if one is flopping down, it is a sign too

Speech
Victim may appear confused and have difficulty speaking

Time
is of the essence. Get to the hospital FAST!

Treatments for stroke

Two haemorrhagic stroke treatments are available for brain aneurysm rupture.

The first method is coiling, where a puncture is made and a platinum thread is guided through the blood vessels to the aneurysm. The coil blocks up the aneurysm, preventing blood flow there and re-rupturing. John of the case study above underwent the procedure.

The second method, used when the opening of the aneurysm is too wide, is open surgery clipping. An incision will be made in the scalp along the neck of the aneurysm and secured with a titanium clip of about one to two centimetres long.

Ischaemic stroke treatment depends on the underlying risk factors. For heavy smokers, people with high cholesterol or diabetics, they may have blood vessels in the neck which are blocked, and surgery may be required to unblock those vessels. This procedure is known as carotid endarterectomy and removes the plaque build-up in the carotid artery that supplies blood to the head.

Reducing the risk of stroke

Of course, prevention is better than cure. Regular check-ups and early detection can minimise the severity of stroke conditions like brain damage and save lives. Knowing how to identify stroke symptoms helps. It is important to get medical help quickly even if the symptoms only last for a few seconds. The effects of stroke are serious, but fast treatment may result in a better recovery.

Publication of this article by courtesy of Dr Tang Kok Kee, Neurosurgeon from Mount Elizabeth Hospital