Stroke:

Risk Factors and Treatment

Stroke is a common condition that usually occurs as a person grows older. People who are affected are usually in their 60's and 70's, although occasionally, some younger people as young as in their 30's or 40's can get a stroke. It is the 4th leading cause of death in Singapore, and the main cause of disability and long-term hospital care. In women, heart disease and stroke combined are the leading cause of death.

Stroke is a "Brain Attack", in which blood and oxygen supply to the brain is cut off. It can occur because an artery to the brain is blocked or ruptures.

Signs and symptoms of a stroke are the following:
  • Sudden weakness or loss of sensation or numbness of the face, arm or leg, usually one side
  • Confusion, or difficulty in speaking
  • Sudden loss of vision in one or both eyes
  • Sudden dizziness or loss of balance or difficulty walking
  • Sudden severe headache
  • Memory loss, dementia, confusion
If such clinical features develop, it will be best to see a doctor for investigations. These signs may be a mild stroke (or transient ischaemic attack, in which the patient recovers after a while) or a more major stroke. Appropriate treatment can then be started to treat the stroke and prevent a second stroke.

Investigations include:

1. MRI brain scan - to determine the type of stroke
2. MRA or CTA (angiogram) - to assess the blood vessels of the brain
3. Blood tests - to determine cholesterol level, glucose level, kidney and liver function.

Types of Stroke

Ischaemic Stroke - The blockage of the blood vessel (artery) is by blood clots from the heart or other parts of the body, or from the gradual build-up of cholesterol and fatty deposits.

Haemorrhagic Stoke - The blood vessel rupture is usually from high blood pressure (hypertension), an abnormal blood vessel such as an aneurysm or arteriovenous malformation.

Risk factors
  • Increasing age
  • Hereditary factors – family history
  • Sex – More men tend to have stroke than women
  • Previous history of stroke, heart disease or vascular disease
  • High blood pressure and Diabetes;
  • Cigarette smoking;
  • High cholesterol; Lack of exercise and Obesity.
  • Some ethnic groups have a higher incidence of stroke than others, for example, in Singapore, Chinese and Indian men have a higher risk than Malay men.
Assessment of Risk of Stroke

1. Past medical history and clinical examination

2. Screening tests - FBC, Renal screen, PT/PTT, CRP, Blood glucose, Lipids and cholesterol, ECG

3. MRI-MRA brain scan

Treatment:

1. For patients with risk factors, medication can be started to reduce the likelihood of stroke. These medications include (1) drugs to control high blood pressure and diabetes, (2) drugs to prevent clot formation (such as Aspirin or Plavix) (3) drugs to lower high cholesterol levels (such as Statins). Optimal level of total cholesterol - less than 200mg/dl.

Healthy life-style habits are also necessary, such as regular exercise, healthy low-salt, low-fat diet, controlling diabetes, and stopping cigarette smoking.

2. For patients with stroke, treatment options include
  • surgery for ischaemic stroke -
    • carotid endarterectomy
    • stenting to improve poor blood flow
  • surgery for haemorrhagic stroke -
    • aneurysm surgery and clipping, or endovascular coiling
    • haematoma aspiration or removal
    • arteriovenous malformation surgery, embolization or gamma knife radiosurgery


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