Stroke is a medical emergency that affects the arteries supplying oxygen rich blood to the brain and can take place over minutes to hours. 2 million neurons are lost every minute and 4 years of brain aging occurs with every passing hour. As such, time is brain and urgent attention is required. A stroke occurs when a blood vessel is blocked (ischemic) accounting for 80% of cases, or ruptured (hemorrhage) in the balance 20%. When this happens, brain cells are deprived of oxygen and begin to die.

Individuals who are susceptible to having a stroke are those who have any of the following conditions:

• Diabetes
• Hypertension
• Cigarette smoking
• High cholesterol levels
• Obesity
• Family history of young stroke
• Cardiac conditions (Atrial fibrillation, valvular disease)
• Rare blood clotting disorders

The symptoms of stroke will depend on the location of blood vessel involved as different parts of the brain regulate different functions of the nervous system. These symptoms include:

• Typically one sided weakness or sensory related symptoms (including clumsiness of limbs, numbness, pins and needles)
• Sudden speech slurring, drooling of saliva
• Sudden loss of speech or sudden confusion
• Loss of consciousness or drowsy mental state
• Severe giddiness or walking unsteadiness
• Sudden visual loss (typically one sided and partial) or double vision

The mnemonic FAST is a good quick reference to identify a person at risk of a stroke. Look out for the following features:

• FACE drooping
• ARM weakness
• SPEECH difficulty
• TIME to call for emergency help

Early detection allows early treatment, which improves outcomes tremendously for the patient. The critical time frame of presenting to the hospital before 3 (and up to 4.5 hours in selected situations) allows emergency infusion of a clot melting treatment to be given to patients with ischemic strokes. These can only be done after urgent assessment and confirmation of diagnosis via a CT scan.

Credits:

Dr. Rishikesan Kuppusamy

Consultant Neurologist, Pantai Hospital Kuala Lumpur