Stroke – 3rd largest cause of death in Malaysia

Stroke is the third largest cause of death in Malaysia after heart disease and cancer. More often than not stroke does not kill. It results in disabilities that affects a person’s ability to continue working or living a normal life. Hence strokes result in hardship, both on patients and their families, who may need to provide prolonged care and support for the affected person.

Strokes are due to sudden interruption of the blood supply to the brain. This can occur in two ways; when a blood vessel is blocked due to a clot (known as ischaemic stroke) or when a blood vessel in the brain ruptures leading to bleeding in the brain (known as haemorrhagic stroke). About 80% of strokes are of the ischaemic type and 20% haemorrhagic.

A stroke on one side of the brain results in loss of function of the opposite side of the body; for example, a blockage of a blood vessel in the left side of the brain results in weakness of the right side of the body.

Strokes or ‘brain attacks ‘usually occur suddenly, out of the blue, and the affected person may not even realise that he or she is having a stroke. It is important to seek medical attention immediately as early treatment may reduce the severity of the stroke and in some cases even reverse it.

If you, a friend or a relative develop the any of the following symptoms suddenly, it may be a sign of stroke:

• Weakness of limbs on one side of the body.
• Numbness or altered sensation on one side of the body.
• Slurred speech, difficulty in talking or problems understanding speech.
• Drooling of saliva from the mouth or problems with swallowing.
• Blurring or loss of vision.
• Dizziness, unsteadiness, or incoordination of movements.
• Drowsiness, confusion or loss of consciousness.
• Severe headache especially if associated with nausea and vomiting.
   

The affected person may also have a combination of the above symptoms.

Sometimes a person with the above symptoms recovers spontaneously and completely within 24 hours. This is known as a transient ischaemic attack (or TIA) and is different from a true stroke. However a person who has had a TIA has a high risk of developing a full-blown stroke (about 10% chance within the next 3 months) and should seek medical advice promptly.

What are the risk factors for developing stroke? One is increasing age and as the population ages there will be an increase in the number of people getting strokes. However the majority of risk factors for strokes can be controlled, both with a healthy lifestyle and medical intervention when necessary.

These risk factors include:

• High blood pressure.
• Smoking.
• Diabetes.
• High cholesterol levels.
• Irregular heart rhythms such as atrial fibrillation.
• Obesity and sedentary lifestyle.
• Unhealthy diets.
• Heavy alcohol consumption.

It is important for us to be aware of these risk factors and to be medically screened for them. Your doctor will be the best person to advice on this. What if you already have a stroke? While early treatment of strokes may reduce its severity, most strokes almost always result in some form of permanent disability. The degree of disability may range from very minor to severe depending on the area and size of the brain that is affected.

Once a stroke is established treatment consists of rehabilitation to assist recovery and medical treatment to prevent further strokes. Rehabilitation includes physiotherapy to help motor recovery, speech therapy for speech problems, occupational therapy to help recover functional abilities and return to work and other supportive therapies.

Medical treatment includes treating risk factors such as high blood pressure, diabetes, high cholesterol levels and modifying lifestyle and diet. If the stroke is of the ischaemic type due to blockage of blood vessels, treatment to prevent further blockages with medication such as anti-platelet drugs, for example aspirin or clopidogrel, would be required. For those with strokes due to irregular heart rhythms such as atrial fibrillation, blood-thinning medication, such as warfarin is usually indicated.

More information on stroke and services for stroke patients can be found on the National Stroke Association of Malaysia website: www.nasam.org