WHAT IS STROKE?
Stroke is the fourth leading cause of death in Brunei, and one of the major cause of disability. A recent World Stroke Organisation analysis of the Global Burden of Disease shows that, globally, the lifetime risk of stroke has risen and that one in four people may suffer a stroke in their lifetime.
Stroke happens when blood flow to the brain is interrupted, either due to blockage of blood vessels or bleeding in the brain.
The brain does not get enough oxygen and other nutrients, causing some brain cells which are affected to temporarily be out of function or die. This can happen as sudden as few minutes or hours.
One may experience imbalance, weakness or numbness in one or more limbs, facial weakness, difficulty in talking or memory impairment. At worst, it can lead to death.
There are generally two types of stroke – ischaemic and haemorrhagic.
Ischaemic stroke means that there is not enough blood supply to the brain cells, which can be due to blockage of the artery by clots or cholesterol plaques.
Haemorrhagic stroke, on the other hand, means bleeding into the brain, mainly due to rupture of blood vessels.
HOW TO RECOGNISE STORKE?
Stroke is a medical emergency. It is important that when a person suddenly develops stroke, those nearby should be able to recognise quickly any one of the symptoms and seek immediate medical attention. The more time is lost, the more brain cells will die.
An easy way to remember is using the mnemonic ‘BE FAST’:
B – Balance: Sudden loss of balance or coordination;
E – Eye: Loss of vision in one eye or experiencing double vision (seeing two separate or overlapping images of the same object, when you should only be seeing one);
F – Face: Facial drooping or weakness on one side;
A – Arms: Weakness or numbness in one or both arms;
S – Speech: Speech may be slurred or incomprehensible words or confused words; and
T – Time: Act quickly, call 991 and go to the emergency department in the nearest hospital.
WHAT HAPPENS THEN?
Treatment in the hospital includes rapid assessment, special investigations such as brain scans and blood tests and, if stroke is the most likely diagnosis, the patient is transferred to the Brunei Neuroscience, Stroke and Rehabilitation Centre (BNSRC) for further management.
In certain cases, thrombolysis is offered to break down the clot that is causing blockage of the blood supply to the brain, using a drug injection. This is done within 4.5 hours from the start of symptoms.
Another option includes mechanical thrombectomy, which is removing the clot by using a wire through a large blood vessel in the hip area.
In some cases where there is bleeding or swelling in the brain, causing increase in pressure within the skull, surgery is performed to remove and stop the bleeding and to relieve the pressure within the skull.
After treatment, stroke patients will undergo rehabilitation to recover from their symptoms or disability.
This may involve doctors, nurses, physiotherapists, occupational therapists, speech and language therapists, clinical psychologists, medical social workers and dietitians, among others.
Patients will undergo a rehabilitation programme to optimise their function and also for reintegration back into society.
PREVENTION IS BETTER THAN CURE
Recovery after stroke is very variable, and some may end up having lifelong disability.
Thus, the best treatment for stroke is definitely prevention.
To prevent, we have to control risk factors that can lead to stroke. These are high blood pressure; high cholesterol; smoking; diabetes mellitus or high blood sugar; obesity; alcohol; and other cardiovascular diseases (for example, heart disease).
Other risk factors can also increase the risk of stroke such as older age and family history of strokes. In which case, one has to be even more careful and adopt a healthier lifestyle.
If you do not know whether you or your loved ones are having these risk factors, it is advised to go to the nearest clinic or hospital for a screening or check-up.
If we can detect and address these risk factors early, it is less likely to develop a stroke later on.
It is important to adopt a healthy lifestyle, which includes eating less oily food, drinking less sweet/carbonated drinks, eating more fruits and vegetables, exercise regularly and stop smoking.
TAKE HOME MESSAGE
Recognise early, treat early! Time is of the essence when it comes to treatment of stroke.
With more time lost, more damage is sustained by the brain and more likely one will end up with more lifelong disability.
Prevention is paramount. Be aware of risk factors that you and your loved ones have or may have, and manage these factors for a better future and quality of life. – PANTAI JERUDONG SPECIALIST CENTRE