20 December 2008

Health Sense: Three important questions can reduce your risk of stroke

Strokes are both common and preventable: 80 percent of strokes are preventable. Recognizing the symptoms and acting fast to get medical attention can help save lives and limit ensuing disabilities a stroke victim may suffer.

In medical jargon, a stroke is a cerebrovascular accident (CVA) and it occurs when a blood vessel in the brain suddenly becomes blocked or bursts. When this happens, blood fails to flow to that area in the brain, cutting off oxygen and nutrients to the brain cells there.

With no blood supply, the brain cells and nerves will die and the capacities that area of the brain controls will be lost, temporarily or permanently. When strokes are severe the sufferer can become paralyzed, unable to speak, or even go into a coma, depending on where the stroke occurs and how much of the brain is damaged.

Strokes can strike anyone at anytime, regardless of sex or age. Typically, stroke symptoms start suddenly, within seconds to minutes, and in most cases do not progress further. On average, two million brain cells die every minute following a typical stroke, which increases the chance of permanent damage, disability or death.

Stroke is the leading cause of disability among adults in the world today and one of the leading causes of death after cancer and heart disease. Disability affects 75 percent of stroke survivors, which can hamper their ability to work.

"The effects of stroke often place a significant burden of care on the patient's family because the stroke survivor often needs assistance in everyday activities we take for granted -- walking, eating, going to the toilet, talking," said Dr. Keith Goh, consultant neurosurgeon at International Neuro Associates, part of Novena Medical Centre and East Shore Hospital in Singapore.

"In addition to physical disabilities, 30 to 50 percent of stroke survivors suffer post-stroke depression -- they may be irritable and withdrawn, have trouble sleeping, and their self-esteem may suffer. In some cases, depression can reduce motivation and worsen patient's condition," he said.

With the effects of stroke being so often drastic, it's good news that they can be prevented. Three vital facts about stroke can help those at risk prevent them from occurring. First, what are the risk factors? Second, what tests can be done to assess an individual's risk? Third, what can be done to prevent a stroke?

Risk factors

Stroke occurs more often in people who fit the following categories. Strokes are more frequent in men than women, more frequent in the over-50 set. Habits and lifestyle choices mark other higher risk groups, including people who are overweight; have high blood pressure or diabetes; smoke tobacco, drink alcohol, and are under stress; do not exercise; and eat a diet high in salt and fat. Anyone with a history of heart disease in themselves or their families has a higher risk of stroke as well.

Signs, symptoms and medical tests

If you have one or some of the following signs or symptoms, even for a short time, you may have experienced a stroke. These include: sudden loss of vision; weakness in the face, an arm or a leg; difficulty talking or understanding speech; or severe headaches, dizziness or loss of balance. Your doctor may advise testing such as computerized tomography (CT) or magnetic resonance imaging (MRI) which provide images of the brain so she or he can look for signs of a stroke. Often the doctor will also ask for an angiogram, to study the blood vessels, or a perfusion scan to assess the pattern of blood flow. Several blood tests are commonly ordered to assess the overall risk of stroke.

F.A.S.T is a simple test for detecting stroke symptoms early. This will allow for immediate and appropriate medical care, which can help prevent death from strokes, and reduce the severity of disability after one occurs.


Ask the person to smile. Does one side of the face droop?


Ask the person to raise both arms. Does one arm drift downward?


Ask the person to repeat a simple sentence. Does the speech sound slurred or strange?


If a person has trouble with any of these simple commands, emergency services should be called immediately.

Stroke prevention

If you have any risk factors described above, your doctor will advise you on how to reduce the likelihood of a stroke. Regular medical check-ups to monitor and treat high blood pressure, diabetes mellitus, high cholesterol and heart disease; leading a healthy lifestyle, regular exercises, stress reduction and not smoking will help to prevent an onset of stroke.

"Sometimes medication will need to be given, such as anti-platelet drugs or anti-coagulant drugs, to prevent blockage of a blood vessel. And if there are blood vessel abnormalities, which may lead to bleeding in the brain, then surgery may be needed," said Dr. Charles Siow, a consultant neurologist, also on staff at International Neuro Associates.

Everyone has some stroke risk. While some factors are beyond your control, regular check-ups and early detection can help reduce the likelihood and reduce the severity of any stroke you do experience. The Neurosurgery and Neurology Specialists of International Neuro Associates provides a stroke risk assessment consultancy service, where a panel of blood and radiology tests are performed to assess a patient's risk of stroke. Costing S$1,500 (US$1,015), the stroke risk screening package includes; MRI and MRA scans; blood tests (FBC, renal panel, HBA1C, lipid panel, CRP, PT/PTT); ECG; clinical assessment and consultation with a neurologist or neurosurgeon.

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