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Strokes are a feared medical condition not only because they can kill but also because they can cause sudden and long-term disability.

What is Stroke?

Strokes occur when a part of the brain does not get sufficient blood supply.  This may be the result of a blood vessel blockage (ischaemic stroke) or rupture (haemorrhage stroke) in the brain.  Blood vessel blockages may occur with blood clots forming directly in blood vessels in the brain (thrombotic stroke), around regions of blood vessel walls with fatty deposit build-up.

Blood clots could also travel from the heart (formed in the heart from abnormal stasis of blood due to impaired heart function) or arteries in the next to block blood vessels in the brain (embolic stroke).  Blood vessel rupture may occur due to a region of blood vessel wall thinning or weakness (eg. aneurysm)

What are the symptoms of Stroke?

• sudden hemi-body numbness/weakness/clumsiness
• swallowing difficulties, slurring of speech or comprehension difficulties
• double vision or sudden loss of vision in one eye
• sudden loss of balance, unsteadiness of gait or dizziness
• sudden alteration  of conciousness
• sudden, most severe headache of your life

Transient ischaemic attack (TIA) refers to symptoms that usually last under an hour (up to 24 hours) and are regarded as ‘mini strokes’ or ‘warning of impending strokes’.  These occur when the blood supply to the affected brain is transiently cut off.  If left untreated, up to a third of patients with TIA may go on to have a full-blown strokes.

Relatively small strokes are termed lacunar strokes with larger ones may affect the circulation of the anterior (front 2/3 of the brain) or posterior (rear 1/3 of the brain including the brainstem) regions of the brain either partially or totally.

How to identify the risk factors of stroke?

Age, smoking, hypertension, hypercholesterolaemia, diabetes mellitus, and heart disease all increases the risk of stroke.  Severly narrowed blood vessels in the neck and brain also increase the risk for stroke.  There is an increasing evidence that high homocysteine (an amino acid) levels in the blood and obstructive sleep apnoea (presenting with snoring and excessive daytime sleepiness) may also be independent risk factors for stroke.

In Part 2, we will explore on the examinations and diagnosis of stroke, treatments, early complications of strokes etc.

P.S. Thanks to Dr Andrew Pan (MBBS, MRCP, FAMS)

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