Stroke

A stroke occurs when blood flow to part of the brain is disrupted, causing brain cells to die due to a lack of oxygen. This interruption can result from either a blocked blood vessel (ischaemic stroke) or a ruptured blood vessel (haemorrhagic stroke). The effects of a stroke depend on the area of the brain affected and may include difficulties with movement, speech, and cognitive functions. Timely medical intervention can help reduce brain damage and improve recovery.

Dr. Teo Kejia

Senior Consultant Neurosurgeon

MBBS (Singapore) | MRCS (Edinburgh) | FAMS (Neuro.Surg) | FRCS Ed (Neuro.Surg) | IFAANS

Symptoms Causes Types Diagnosis Treatment Prevention FAQ

Symptoms of Stroke

Recognising stroke symptoms early allows for prompt medical treatment, which can help minimise brain damage. The most common symptoms include:

Facial Drooping: One side of the face may feel numb or appear uneven, making it difficult to smile, close the eye fully, or move facial muscles symmetrically.
Arm Weakness: Weakness or numbness in one arm may make it difficult to raise both arms and keep them elevated. The affected arm may drift downwards or feel significantly weaker than the other.
Speech Problems: Speech may become slurred, difficult to understand, or completely incoherent. Some individuals may struggle to form words, while others may have trouble understanding spoken language.
Vision Changes: Blurred, reduced, or lost vision in one or both eyes may occur. Some people experience double vision or find it difficult to focus.
Balance Issues: Sudden dizziness, difficulty walking, or a loss of coordination may develop, making it hard to stand or move steadily.
Severe Headache: A sudden, intense headache with no obvious cause may occur. It is often described as the worst headache ever experienced and may be accompanied by nausea, vomiting, or confusion.

Causes and Risk Factors

Several factors contribute to stroke risk. Identifying and managing these factors can help with prevention.

High Blood Pressure

Long-term high blood pressure weakens blood vessels, increasing the risk of blockages or ruptures. It is one of the leading causes of both ischaemic and haemorrhagic strokes.
Diabetes

Uncontrolled diabetes damages blood vessels, increasing the likelihood of clot formation. It also contributes to high blood pressure, further raising stroke risk.
Heart Disease

Conditions such as atrial fibrillation, heart valve disorders, and atherosclerosis can lead to clot formation, which may travel to the brain and cause a stroke.
Smoking

Tobacco use damages blood vessel walls, making them more susceptible to narrowing and clot formation. It also raises blood pressure, compounding stroke risk.
High Cholesterol

Excess cholesterol in the blood can form plaques in arteries, restricting blood flow and increasing the likelihood of a clot causing a stroke.
Obesity and Poor Diet

An unhealthy diet high in saturated fats, salt, and processed foods contributes to conditions such as high blood pressure, diabetes, and high cholesterol, all of which increase stroke risk.
Physical Inactivity

Lack of exercise can lead to weight gain, poor cardiovascular health, and increased stroke risk. Regular movement helps maintain blood flow and reduce clotting risks.
Age

Stroke risk increases with age, particularly after 55. However, strokes can also occur in younger adults due to other medical conditions.
Family History

Genetic factors and inherited conditions may contribute to stroke risk, particularly in individuals with a strong family history of heart disease or stroke.

Types of Stroke

Ischaemic Stroke

Caused by a blood clot blocking an artery supplying the brain. Clots may form in brain arteries or travel from other areas, such as the heart or neck arteries. Restoring blood flow quickly can help prevent permanent brain damage.

Haemorrhagic Stroke

Occurs when a blood vessel ruptures, leading to bleeding in or around the brain. This causes pressure that damages brain tissue. Common causes include weakened blood vessels and uncontrolled high blood pressure.

Transient Ischaemic Attack (TIA)

Often called a mini-stroke, a TIA occurs when blood flow to part of the brain is temporarily blocked. Symptoms usually resolve within 24 hours, but a TIA signals a higher risk of a full stroke. Immediate medical attention can help prevent a future stroke.

Diagnostic Methods

Physical Examination

A medical assessment includes checking for muscle weakness, speech difficulties, vision changes, and coordination problems. Medical history, current medications, and stroke risk factors are also reviewed.
Brain Imaging

CT and MRI scans provide detailed images of the brain to identify affected areas, determine the type of stroke, and detect any bleeding or blockages. These scans are required to differentiate between ischaemic and haemorrhagic strokes.
Blood Tests

Blood tests assess clotting function, blood sugar levels, and cholesterol levels. They also help rule out conditions that may mimic stroke symptoms.
Heart Tests

ECGs and echocardiograms evaluate heart function and structure to identify potential sources of blood clots, such as irregular heart rhythms or heart valve abnormalities.

Treatment Options

Treatment focuses on restoring blood flow in ischaemic strokes, controlling bleeding in haemorrhagic strokes, and preventing further damage to brain tissue.

Non-Surgical Treatment

Clot Dissolution Medications: For ischaemic strokes, thrombolytic drugs can dissolve blood clots if given within 4.5 hours of symptom onset. These medications require careful selection due to bleeding risks.
Blood Pressure Management: Medications help control blood pressure to reduce the risk of further damage in both types of stroke. Regular monitoring and dose adjustments may be needed.
Anticoagulation Therapy: Blood-thinning medications help prevent further clot formation after an ischaemic stroke. The choice of medication depends on the underlying cause.

Surgical Treatment

Mechanical Thrombectomy: This procedure removes large blood clots from brain arteries using specialised catheter-based devices. It is typically performed in patients with an ischaemic stroke caused by a major artery blockage. In certain cases, it may be carried out up to 24 hours after symptom onset to restore blood flow and minimise brain damage.
Aneurysm Repair: For haemorrhagic strokes caused by a ruptured aneurysm, our surgeon may either place a clip at the base of the aneurysm during open surgery to stop further bleeding or use minimally invasive techniques to insert coils into the aneurysm, promoting clotting and reducing the risk of rebleeding.
Carotid Endarterectomy: This surgical procedure removes plaque build-up from the carotid arteries in the neck, improving blood flow to the brain. It is recommended for patients with significant narrowing of these arteries to help prevent future strokes, particularly in those who have already experienced symptoms of reduced blood supply to the brain.

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Prevention and Management

Stroke prevention involves lifestyle adjustments and medical management to control risk factors. Maintaining normal blood pressure, blood sugar, and cholesterol levels can significantly reduce stroke risk. A balanced diet rich in fruits, vegetables, and whole grains, combined with regular physical activity, supports heart and brain health. Avoiding smoking and moderating alcohol intake further reduces stroke risk.

For individuals who have had a stroke, rehabilitation programmes focus on regaining lost abilities and adapting to any lasting effects. This may include physical therapy for movement recovery, occupational therapy for daily activities, and speech therapy for communication difficulties. Ongoing medical care and lifestyle modifications can support long-term recovery and prevent future strokes.

Frequently Asked Questions (FAQ)

How soon should someone seek medical help after noticing stroke symptoms?

Medical help should be sought immediately. Treatment is most effective when started as soon as symptoms appear. Calling emergency services is recommended, as paramedics can begin assessment and treatment while en route to the hospital.

Is it possible to have multiple strokes?

Yes, having one stroke significantly increases the risk of experiencing another, especially if underlying risk factors such as high blood pressure, diabetes, or atrial fibrillation are not managed.

How long does stroke rehabilitation last?

Recovery time varies depending on stroke severity and the affected brain areas. Significant improvements often occur within the first three to six months, but recovery can continue for years with ongoing therapy and exercise.

Dr. Teo Kejia

Senior Consultant Neurosurgeon

MBBS (Singapore)|MRCS (Edinburgh)|FAMS (Neuro.Surg)|FRCS Ed (Neuro.Surg)|IFAANS

Dr. Teo’s expertise lies in complex brain tumour surgeries employing advanced techniques like brain mapping and awake brain surgery. He also manages neurovascular conditions, traumatic head injuries and spinal disorders.

Dr. Teo graduated from the National University of Singapore with a Bachelor of Medicine and Bachelor of Surgery in 2006. He completed his general surgery training and advanced neurosurgery training at the National University Hospital Singapore. He furthered his education in the United Kingdom, obtaining advanced certifications and completing specialist training in various neurosurgical disciplines.
Dr. Teo’s AMDA award facilitated his training at Queen’s Hospital in London, where he specialized in functional neurosurgery, neuro-oncology, neurovascular, skull base, and spinal surgery. He also underwent fellowship training in brain mapping and awake brain surgery at renowned institutions in Italy and France, working with leading experts in the field.

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