What is stroke?
Stroke is an illness in which part of the brain is suddenly and severely damaged or destroyed by the interruption of the normal blood flow. The result is loss of function in that part of the brain. This usually causes weakness, paralysis of the arm and leg on either the left or right side of the body, and twisting of the face. In some cases, there are other effects such as loss of balance, disturbance of vision or speech, loss of control of the bladder & bowel and difficulty with swallowing.

What causes stroke?
Stroke is an unpredictable and potentially deadly disease. Hence identification of the risk factors and avoiding/correction of these factors are important to prevent strokes.

1. High blood pressure
   Increases the risk of stroke and treating high blood pressure reduces the risk of stroke. High salt intake has been connected with increased blood pressure. It is wise to avoid heavily salted food. There is probably no harm in moderate intake.
2. Cigarette smoking
   For people who smoke 20 cigarettes a day, the chances of having a stroke are about three times greater than those who do not smoke.
3. High blood cholesterol
   The evidence that high blood cholesterol levels may lead to the development of heart problems including heart attacks is well established. There is also evidence that high cholesterol levels can cause the development of cerebral (brain) artery disease.
4. High blood sugar
   The incidence of stroke is higher in people who are diabetic.
5. Oral contraceptive pill
   There is an increased risk in the incidence of stroke, especially in young women who have a family history of arterial disease.
6. Unknown factors
   Strokes can occur to someone without any definite risks factors.

What are the types of stroke?
There are two main types:

1. Occlusive stroke - the blood vessels are blocked by :
   a. Progressive narrowing of vessels (thrombotic)
   b. Movement of blood clots from other parts of the body (embolic)
2. Haemorrhagic stroke - rupture of blood vessels.
   The two types of stroke can be distinguished by neuroimaging:
   1. CT - Computerized Tomography
   2. MRI- Magnetic Resonance Imaging

What are the available treatments?

1. Early stroke
   Within 6 hours of an occlusive stroke (brain attack), treatment options include the use of drugs to dissolve the blockage.
2. Medication
   Certain medications like anti-platelets or anti-coagulation agents can be used to prevent other blockages of blood vessels.
3. Surgery
   Certain occlusive strokes and haemorrhagic strokes may need surgery to prevent death or potentially bad neurological outcomes.
4. Rehabilitation
   Most strokes, both haemorrhagic and occlusive will need further rehabilitation to restore potential functional independence.

What is a TIA (Transient Ischaemic Attack)?
Transient = symptoms disappear in less that 24 hours
Ischaemic = failure of blood flow to part of the brain or eye
Attack = sudden onset of symptoms which varies from one person to another depending on which part of the brain is affected.

They are also known as mini-strokes. The symptoms can be very similar to strokes but they do not last nearly as long. Common symptoms of TIA include brief attacks of weakness, clumpsiness, numbness, pins & needles of the face, arm, or leg; slurring of speech or difficulty in finding words; brief loss of vision in one or both eyes. TIAs do not usually cause blackouts, fainting or loss of consciousness.

What is the significance of TIAs?
There are several other illnesses which may present the same symptoms of TIAs, and some of them may be life-threatening. So it is important that people with any of the TIA symptoms seek medical consultation to determine the correct diagnosis.

Although TIAs may be frightening, they do not cause any permanent damage. However, a person who has had TIA has a greater risk of suffering a stroke. The risk of having a stroke in the first year after a TIA is about 10 % but then drops about 5% each year.

A TIA can be a warning sign of increased risk of heart attacks.

What treatment is available for TIA?
The treatment includes the identification of the risk factors and their correction whenever possible. Anybody who smokes should stop the habit completely. For people with high blood pressure, high blood cholesterol and blood sugar, adopting an improved lifestyle with healthier diet and regular exercise, at times with help of medication, can minimize the risk factors. Medications prescribed for thinning the blood is also helpful. If the TIA is due to a narrowing of the major blood vessel in the neck, an operation called carotid enterectomy might be necessary.

Normah Medical Specialist Centre is fully equipped and appropriately staffed for the complete management of stroke.

Mr. H.S. Ching, Medical Director,
Consultant Neurosurgeon