Being mindful of stroke

1. What are the different types of stroke?
Stroke happens when the blood flow to the brain is disrupted, preventing oxygen and nutrients from reaching the brain tissue. This in turn damages brain cells, causing them to stop functioning and triggering the symptoms and signs of stroke.

There are two main types of stroke:

Ischaemic stroke

• This is the most common type of stroke – about 4 in 5 cases – is caused by a blockage of a blood vessel in the brain.

Haemorrhagic stroke

• The remaining 1 in 5 cases of stroke are haemorrhagic and occur when a blood vessel bursts, causing blood to leak into the brain tissue.

Both types of stroke are medical emergencies because timing is everything when it comes to stroke – nearly two million brain cells die every minute that a stroke is left untreated!

Transient Ischaemic Attack (TIA), or “mini stroke”, occurs when there is a temporary blockage in a blood vessel in the brain. Stroke symptoms would present themselves for a few minutes and disappear when the blood flow is re-established and the brain tissue recovers, allowing it to function again. But patients still need to go to the Emergency Department as they are at a higher risk of getting a full-blown stroke.

2. How is stroke treated?
Treatment depends on many factors, such as the type of stroke, when it happened, how much of the brain is affected and the patient’s underlying health conditions.

Call 995 for an emergency ambulance if someone is experiencing signs of stroke. Paramedics can administer First Aid and rush the patient to the hospital. Acute treatment of stroke is proven to improve outcomes, limit disability and increase the likelihood of independence post-stroke.

Acute treatment for ischaemic stroke may include medication to dissolve the blood clot that is causing the blockage (thrombolysis) and/or a procedure to extract the clot or fatty deposit from the blood vessel (thrombectomy). These treatments must be performed within a certain amount of time from when stroke symptoms first occur.

Acute treatment for haemorrhagic stroke may include a procedure or surgery to repair the damaged blood vessel and prevent/manage complications caused by the leaked blood pooling in the brain.

Treatment of a stroke patient involves a multidisciplinary team and includes preventing, screening and treating known complications of stroke; managing temperature, blood pressure and fluids/ nutrition; establishing the cause of stroke and starting treatment to prevent another stroke; early mobilisation and rehabilitation; as well as helping the patient and family to manage and cope with the consequences of stroke.

3. What are the signs of stroke?
A stroke can strike anyone at any time, even while you are asleep. Around 8,300 people have a stroke in Singapore every year and around 1 in 4 cases are under 60 years old. Hence it is important to know the signs of stroke and what to do if you spot them.

The easiest way to recognise the signs of stroke is to act FAST:

• Face – drooping on one side of the face. Ask the person to smile and see if one side of the mouth is drooping.
• Arms – weakness in one arm. Ask the person to raise both arms above his/her head and see if one arm is drifting downwards.
• Speech – slurred or confused speech. Ask the person to repeat a short, simple phrase such as “it is sunny today” and listen if the words are slurred or jumbled up.
• Time – call 995 for an emergency ambulance if you spot at least one of the above signs. Calling 995 will give you the fastest access to treatment when you arrive at hospital as the ambulance crew will inform the receiving hospital that a suspected stroke case is on the way. The medical team can then be activated and waiting for you when the ambulance arrives.

4. How can I reduce my risk of stroke?
4 in 5 strokes can be prevented. Here are 5 ways to reduce your risk of stroke:

a. Go for a health screening
High blood pressure, high cholesterol and diabetes are major risk factors of stroke. But all three often do not show any symptoms – you will not know you have these risk factors unless you go for screening. Subsidised health screening costing $5 or less is available for Singaporeans under the Health Promotion Board’s National Health Screening Programme.

b. Take medication as prescribed
If you have any of the risk factors, you may be put on medications to reduce stroke risk. Taking these medications – often long-term – as prescribed by your doctor will control blood pressure, cholesterol levels and diabetes. If you experience any side-effects, tell your doctor so the dose can be adjusted and/or different medication can be prescribed to find a combination that works well for you. Other stroke risk factors such as atrial fibrillation and heart and blood disorders can also be reduced with medication.

c. Quit smoking
Smoking causes damage throughout your body, including the blood vessels in your brain. If you are a smoker, quitting the habit is one of the biggest favours you can do for your body. Your risk of having a stroke will start falling as soon as you stop. After five years of quitting, your risk of having a stroke will be equivalent to someone who has never smoked.

d. Watch your weight
Obesity increases your risk of stroke. Excess body weight is also closely linked to high blood pressure, high cholesterol and diabetes. Losing weight and maintaining an optimal body weight will help to reduce the risks of these diseases and conditions.

e. Get active!
Stroke risk is higher with a sedentary lifestyle. Aim to complete at least 150 minutes of moderate physical activity every week. Find an exercise routine that suits your lifestyle and personality. Regular exercise helps to reduce obesity and aids in the prevention and management of high blood pressure, high cholesterol and diabetes.

This FAQ article is contributed by Associate Professor Deidre Anne De Silva, Head and Senior Consultant, Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus).