by Dr Tan Kenny – Consultant Neurologist & Physician 

(Subspecialty in Parkinson’s Disease & Movement Disorders)

Having sudden facial or limb weakness and numbness?
Sudden slurred speech or drooling?
Sudden blurred vision?
Is that a concern?
What is going on with your body?

Stroke is preventable and treatable. It is important to recognise early stroke symptoms and BE FAST to act during the golden hour so that immediate emergency stroke treatment can be initiated to reduce brain injury.

Stroke occurs when there is reduced blood supply to the brain. In general, stroke can be classified based on the etiology of reduced blood supply, i.e. ischemic (blockage) and hemorrhagic (bleed). Ischemic stroke is the most common type of stroke. Symptoms suggestive of stroke include sudden poor balance, visual problems, face or limb weakness or numbness, speech difficulty. An easy acronym to remember is BE FAST (Balance Difficulties, Eyesight Changes, Face Weakness, Arm Weakness, Speech Difficulties, Time to call for help).

Around 2 million brain cells die every minute during acute stroke, increasing the risk of permanent brain damage, disability or death. Thus, it is pertinent to identify stroke early so that the necessary medical treatment can be implemented.

Upon reaching the hospital, the neurologist will initiate emergency stroke assessment to establish the diagnosis of ischemic stroke before initiating acute stroke treatment. One such treatment is thrombolytic therapy, i.e., administration of a ‘clot buster’ medication to dissolve blood clots that have blocked the arteries in the brain causing stroke, in the hopes of breaking the clot to reperfuse and return blood flow to the affected brain cells. To be effective, the therapy needs to be initiated as soon as possible within the golden hour (4.5 hours from the onset of symptoms), before permanent irreversible damage has occurred.

For ischemic stroke patients who arrive beyond the treatment window period (>4.5 hours) and not suitable for acute thrombolytic therapy, appropriate investigations and medical treatment to stabilise patient will be initiated i.e. blood thinners, blood pressure and blood sugar control. The first three months after a stroke are the most important for recovery as patients will see the most improvement. Thus, besides providing best medical treatment, patient will require neuro-rehabilitation i.e. physiotherapy, occupational therapy and speech therapy.

Stroke can be debilitating but the bright side is it can be prevented and may be attributed to modifiable and non-modifiable risk factors

In Malaysia, hypertension was the most common risk factor followed by diabetes mellitus. Modifiable risk factors are the focus of primary prevention and they include the following risk factors:

a) Lifestyle, i.e., smoking, unhealthy diet, lack of physical activity.

b) Metabolic, i.e., hypertension, diabetes, high cholesterol, obesity (measured by high body mass index or BMI)

c) Environmental, i.e., stress, air pollution.

Many are not aware that stroke can recur. The recurrence rates are 3-4% in the first month and 12% in the first year after a stroke. This emphasises the importance of secondary stroke prevention, and this may involve medical interventions including anti-platelet therapy, anti-hypertensive treatment, cholesterol and blood sugar control. Besides compliance to medication, lifestyle modification plays a vital role.

It is recommended to maintain an active lifestyle by exercising 30 mins daily or at least 150 mins per week, stop smoking, avoid heavy alcohol drinking and healthy diet. Mediterranean diet (low glycemic with high intake of vegetables) supplemented with nuts, diet high in fruits and leafy green vegetables are beneficial. It is also recommended to follow the Dietary Approaches to Stop Hypertension (DASH diet) to reduce blood pressure, emphasising on high consumption of fruits, vegetables, whole grains, low-fat dairy foods, legumes and nuts, and low intake of sodium, sweetened beverages, and red and processed meat.

In Malaysia, there is still lack of awareness in regards to recognition of stroke symptoms and the significance of time-sensitive stroke treatment. As a result, delay in early intervention may lead to prolonged hospital stay and increase of stroke-related morbidities and mortality. BE FAST to ensure better outcome as time loss is brain loss in acute stroke. Stroke strikes fast, so should you.