Stroke is a significant health issue that affects millions globally, and Malaysia is no exception. It is one of the leading causes of disability and death in the country, impacting not only the individual who suffers but also their families.

Let’s understand more about stroke in this article.

The Definition of a Stroke

A stroke occurs when the blood supply to a part of the brain is disrupted, either due to a blockage or a rupture in a blood vessel. This interruption deprives brain cells of oxygen and nutrients, causing them to die within minutes. Prompt treatment plays a vital role in minimising brain damage and improving outcomes.

Types of Strokes

There are three primary types of strokes, with each type has distinct characteristics, causes, and implications for the patient.

Ischemic Stroke

Ischemic stroke is the most common type of stroke, making up 87% of cases globally. It happens when a clot blocks blood flow to the brain, leading to a lack of oxygen and nutrients. This blockage is often due to fatty deposits in the blood vessels or clots from other parts of the body. Treatment involves quickly dissolving or removing the clot using medications like tPA or mechanical thrombectomy.

Haemorrhagic Stroke

Haemorrhagic stroke is caused by a burst blood vessel in the brain, leading to bleeding and pressure that harms nearby brain tissue. It can be due to conditions like high blood pressure, aneurysms, or trauma. There are two types of haemorrhagic stroke: bleeding within the brain tissue or bleeding in the space around the brain. Treatment typically involves stopping the bleeding, reducing pressure, and repairing the damaged vessel with surgery or other procedures.

Transient Ischemic Attack

A transient ischemic attack (TIA) is a temporary blockage of blood flow to the brain, resembling a stroke but with symptoms that resolve within 24 hours and no permanent damage. It is a warning sign of a potential major stroke and requires immediate medical attention to address underlying risk factors and prevent future strokes.

Causes of Stroke

The prevalence of stroke in Malaysia is affected by numerous common causes and risk factors such as:

• High blood pressure which puts extra strain on blood vessels, increasing the likelihood of blockages or ruptures.
• High levels of cholesterol contribute to the formation of plaques in arteries, leading to atherosclerosis and an increased risk of ischemic stroke.
• Diabetes can damage blood vessels and accelerate atherosclerosis, significantly raising the risk of stroke.
• Conditions like atrial fibrillation, which causes irregular heart rhythms, can lead to the formation of blood clots that may travel to the brain.
• Smoking damages blood vessels, raises blood pressure, and accelerates plaque formation, making it a significant risk factor.
• Obesity contributes to other risk factors like hypertension, diabetes, and high cholesterol.
• A sedentary lifestyle increases the risk of conditions such as obesity, hypertension, and diabetes, which are associated with strokes.
• Diets high in salt, sugar, and saturated fats and low in fruits and vegetables contribute to conditions like high blood pressure, obesity, and high cholesterol.
• Excessive alcohol intake raises blood pressure and weakens the heart muscle, increasing stroke risk.
• A family history of stroke or cardiovascular disease can elevate the likelihood of experiencing a stroke.

Causes of a Stroke in Women

Women have unique risk factors that make them more susceptible to stroke. In Malaysia, stroke among women is becoming increasingly prevalent due to the following causes:

• Pregnancy Complications: Conditions like preeclampsia and gestational diabetes elevate stroke risk.
• Oral Contraceptives: Birth control pills can increase the risk, especially in women with high blood pressure.
• Hormonal Changes: Menopause and the associated decrease in oestrogen levels can affect blood vessels.
• Hormone Replacement Therapy (HRT): Used for managing menopause symptoms, HRT slightly raises the risk of stroke.
• Migraine with Aura: Women who experience migraines with aura are at a higher risk of ischemic stroke.
• Autoimmune Diseases: Conditions like lupus, which are more common in women, can lead to inflammation and blood clots.
• Atrial Fibrillation: This irregular heart rhythm is a significant risk factor in older women.

Signs and Symptoms of a Stroke

Recognising the signs and symptoms of a stroke early can save lives and reduce the potential for long-term damage. The most common symptoms to watch for are:

F.A.S.T. Method (for quick identification)

• F – Face drooping: One side of the face may feel numb or droop. Check if the person can smile and see if the smile is uneven.
• A – Arm weakness: One arm may be weak or numb. Ask the person to raise both arms and see if one arm drifts downward.
• S – Speech difficulty: Speech may be slurred or hard to understand. Utter a simple sentence, ask the person to repeat and see if they can do so correctly.
• T – Time to call emergency services: If any of these signs are present, call emergency services immediately. Time is critical in stroke treatment.

 Other Symptoms to Watch For

• Sudden weakness or numbness, especially on one side of the body
• Trouble speaking, sudden confusion or difficulty understanding speech
• Sudden vision problems in one or both eyes
• Sudden difficulty walking, dizziness, loss of balance, or lack of coordination
• Severe headache with no known cause, often accompanied by nausea or vomiting

Importance of Seeking Immediate Medical Attention

Seeking immediate medical attention during a stroke is crucial to minimise brain damage and improve recovery outcomes. The first few hours after a stroke are crucial, as brain cells begin to die without oxygen and nutrients. Timely treatment, such as clot-busting medications or procedures to remove blockages, can significantly improve chances of recovery and prevent complications like permanent disability or cognitive impairment. Recognising stroke symptoms and seeking emergency care promptly is essential.

Treatment for Strokes

The treatment for a stroke depends on the type of stroke (ischemic or haemorrhagic) and how quickly medical care is received. The main goal is to restore blood flow to the brain and prevent further damage. Here are the primary treatment options:

Treatment for Ischemic Stroke (caused by a blockage in a blood vessel)

The most common treatment for ischemic stroke is the administration of tissue plasminogen activator (tPA), which can dissolve the clot and restore blood flow if given within 3 to 4.5 hours of the stroke’s onset.

If tPA is not an option or if the clot is too large, doctors may perform procedures such as mechanical thrombectomy, where a catheter is used to remove the clot directly. To prevent further clotting, patients may be prescribed aspirin or other blood thinners.

Treatment for Haemorrhagic Stroke (caused by bleeding in the brain)

If there is a brain haemorrhage, surgery may be required to repair the blood vessel, remove the blood clot, or relieve pressure on the brain. In some cases, the surgeon may need to remove blood that has pooled in the brain to prevent further damage.

To control bleeding and lower blood pressure, medications may be given to prevent further bleeding or to reduce the pressure on the brain.

Rehabilitation and Recovery After a Stroke

Recovery after a stroke is crucial for patients to regain independence and improve their quality of life. The rehabilitation plan, tailored to the severity of the stroke, affected brain areas, and overall health, usually includes physical therapy, occupational therapy, speech therapy, and psychological support.

• Physical Therapy: Physical therapy focuses on helping patients regain strength, mobility, and coordination through techniques like improving movement and balance, strengthening exercises, and relearning basic movements after conditions like a stroke.
• Occupational Therapy: Occupational therapy helps patients regain the ability to perform daily activities independently, including self-care tasks such as dressing and cooking, and improving fine motor skills such as hand-eye coordination and dexterity.
• Speech and Language Therapy: Speech therapy for stroke patients focuses on improving speech clarity and language comprehension and helping with swallowing difficulties. Therapists also help with cognitive communication therapy for memory, attention, and problem-solving.
• Psychological and Emotional Support: After a stroke, emotional and psychological impacts such as depression, anxiety, and personality changes can take place. Rehabilitation may include counselling and therapy to help cope with emotions, as well as support groups to connect with others who have had similar experiences and share coping strategies.
• Vocational and Social Reintegration: The rehabilitation process for patients includes helping them return to work, social activities, and community involvement through vocational therapy to assist with job reintegration and social support to rebuild relationships and emotional well-being. The first 3 to 6 months after a stroke are crucial for recovery. Improvement can continue for months or even years with ongoing therapy and management for speech, mobility, and psychological health.

Preventative Measures to Reduce the Risk of Strokes

Preventing a stroke is often possible by addressing key risk factors and adopting a healthy lifestyle. Here are some important preventive measures to reduce the risk of strokes:

• Control High Blood Pressure (Hypertension): High pressure is the main cause of stroke. To manage pressure, it is important to monitor it regularly, take prescribed medications, and make lifestyle changes such as reducing salt intake, eating a balanced diet, exercising regularly, and managing stress.
• Manage Cholesterol Levels: High cholesterol can cause plaque buildup in arteries, leading to a higher risk of stroke. To manage cholesterol levels, focus on a heart-healthy diet rich in fibre and healthy fats, and low in saturated fats. Medications such as statins may be prescribed to lower cholesterol, and regular exercise can help improve cholesterol levels.
• Control Diabetes: Diabetes can increase the risk of stroke if sugar levels are uncontrolled. To reduce this risk, it is important to monitor sugar levels through diet, exercise, and medication. Regular checkups with healthcare providers are essential for managing diabetes effectively.
• Maintain a Healthy Weight: Being overweight or obese raises the risk of stroke by contributing to other risk factors such as high blood pressure, diabetes, and high cholesterol. To lower your risk, focus on eating a balanced diet with whole foods like fruits, vegetables, lean proteins, and whole grains. Also, stay active with at least 150 minutes of moderate exercise per week to maintain a healthy weight.
• Quit Smoking: Smoking significantly increases the risk of stroke by contributing to the buildup of plaque in the arteries and increasing blood pressure.
• Eat a Healthy Diet: Eat a diet that includes fruits, vegetables, whole grains, lean proteins, and healthy fats to lower your risk of stroke. Avoid foods high in salt and processed ingredients, which can raise blood pressure. Increase your intake of fibre and antioxidants found in whole grains, leafy greens, and berries to improve heart health.

Summing it Up

Stroke is a life-altering event that can be devastating for individuals and their families. By understanding the stroke meaning, types of strokes, stroke causes, and treatment options, families in Malaysia can take proactive steps to prevent and manage this condition. Early intervention and lifestyle changes are key to improving outcomes and reducing the impact of stroke on families.

Through education and awareness, we can work together to combat the rising prevalence of stroke and create a healthier future for all Malaysians.

Sources:

• https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes
• https://my.clevelandclinic.org/health/diseases
• https://www.healthline.com/health/stroke
• https://www.nia.nih.gov/health/stroke/stroke-signs-causes-and-treatment
• https://www.cdc.gov/stroke/signs-symptoms
• https://www.nhs.uk/conditions/stroke
• https://www.stroke.org.uk/stroke/types
• https://www.webmd.com/stroke