All You Need to Know About Stroke

Stroke is the second leading cause of death in the world. It is the leading cause of adult disability. 63 percent of stroke patients have some disability at three months. It is the fourth most common cause of death, accounting for more than 10 percent of all deaths in Singapore. According to MOH data. The number of stroke episodes increased from 5,760 episodes in 2009 to 8,326 episodes in 2018. (Yeng et al., 2020)

Stroke happens when a part of the brain is damaged due to the lack of blood supply to the brain area. This is usually due to blood vessel carrying blood to the brain is disrupted. There are two kinds of causes:  

  • The first type is where a blood vessel carrying blood to the brain becomes obstructed. This type of stroke cause by blocked blood vessel is known as Ischaemic Stroke. 

  • The second type is where blood flow is interrupted because a blood vessel carrying blood to the brain bursts. The bursting of the blood vessel leads to bleeding into the brain. This is known as Haemorrhagic Stroke

If a stroke event symptom last more than 24 hours, it can be life-threatening or disabling. Otherwise, where the symptoms is shorter than 24 hours, it is called a Transient Ischemic Attack (TIA), also known as mini-stroke in lay man terms. Most TIAs only last 10 to 30 minutes. (Stroke and Transient Ischaemic Attacks, 2004) 

Symptoms of Stroke 

As different part of the brain performs a different function, the symptoms of stroke depend on which part of the brain is affected. Common stroke symptoms include (Pointers in red are unique identifier in stroke):  

  • Weakness or numbness of the face, arm and leg on one side of the body,  

  • Slurred or unclear speech  

  • Double vision 

  • Difficulty in swallowing 

  • Giddiness 

  • Severe headache 

  • Loss of consciousness and coma 

Stroke symptoms may occur suddenly, or develop gradually. In a TIA event, the symptoms disappear within 24 hours (Usually 10-30minutes). The symptoms may reappear as a stroke or TIA. It may resemble the first onset, or be completely different. (Stroke and Transient Ischaemic Attacks, 2004) 

Responding to a Stroke: What should you do if you have stroke symptoms?  

Call for help and get to the hospital as soon as possible. If the patient is unable to walk call for an ambulance in order that you can get to a hospital as soon as possible. (Stroke and Transient Ischaemic Attacks, 2004) Please read further on our article on Step-by-Step guide: Responding quickly to stroke patients. 
 

Hospital Investigation for a Suspected Stroke?  

One or more of the following investigations may be necessary:

1. Brain scan (should be done as soon as possible) 

  • Computed tomography (CT) - most widely used. can give help to detect the nature and site of the stroke.  

  • Magnetic resonance imaging (MRI) - may show strokes earlier than CT, as well as very small strokes that may not be detected on CT.  

2. Blood tests 

  • Full blood counts (FBC) 

  • Levels of electrolytes  

  • Blood sugar level 

  • Cholesterol and other fats  
    Note: Abnormalities in these may have caused the stroke.  

3. Chest X-ray and electrocardiogram (ECG) These can detect heart disease. 

4. Other investigations:

  • Ultrasound studies of the neck Blood vessels (For some patient) 

  • Ultrasound studies of the heart (For some patient) 

  • Specialised blood tests may be needed for some young stroke patients (Rare) 

(Stroke and Transient Ischaemic Attacks, 2004) 

Immediate Treatment at Hospital 

Suitable treatments depend on the type and cause of the stroke.  

1. For ischaemic stroke

  • The early use of blood thinning medicine reduces the risk of a second stroke.  

 2. Brain surgery  

  • Removal of blood bleed in the brain may be needed if it is pressing on a vital structure or if it is getting bigger with time.  

  • Patients with fluid retention in the brain water channels may have to go for an operation to drain out the excess fluid.  

 3. Medical management  

  • Temperature management for fever cases.  

  • Antibiotics for an infection case 

  • Blood sugar control for diabetic patients 

  • Complication’s prevention such as infections, bed sores, clotting of blood in the veins of the legs and depression. 

(Stroke and Transient Ischaemic Attacks, 2004) 

 
Stroke is cause by damage of the brain due to the disruption of blood supply to the brain either by blockage or busting of blood vessels in the brain. Upon detecting a stroke. Patient should be sent to the hospital as soon as possible so as to prevent potential death or disabling event. Read the upcoming article on Taking Care of a Stroke Patient After Discharge.

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References 

2004. Stroke and Transient Ischaemic Attacks. [ebook] Singapore: Ministry of Health. Available at: <https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/educational-resources/peb_on_stroke_and_transient_ischaemic_attacks.pdf> [Accessed 9 April 2021]. 

Yeng, W., Chen, J., Law, S., Ho, V., Yeo, N., Lee, E., Zheng, H., Foo, L. and Ling, A., 2020. Singapore Stroke Registry Annual Report 2018. [ebook] Singapore: Ministry of Health. Available at: <https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/ssr-web-report-2018.pdf?sfvrsn=58eb7c4c_0> [Accessed 9 April 2021]. 

Singhealth. 2018. Stroke. [online] Available at: <https://www.singhealth.com.sg/patient-care/patient-education/stroke#:~:text=In%20Singapore%2C%203.65%20percent%20of,rise%20with%20our%20ageing%20population.> [Accessed 9 April 2021].