Stroke

Always call 995 for an emergency ambulance if you think you or someone you are with is having a stroke. The emergency ambulance crew will alert the receiving hospital so the patient can receive urgent attention in the Emergency Department when the ambulance arrives. This ensures the patient gets assessed and treated as fast as possible because every minute matters in the treatment of stroke.

• Fa​ce – does the face droop on one side?​
• Arm weakness - ask the person to raise two arms. Does one drop down?
• ​Speech difficulty - is the speech slurred or confused?
  
• Time to call 995 if someone shows one or more of these signs.

There are two types of stroke.

1. Ischaemic Stroke: Blocked Artery
​
This occurs when an artery becomes severely narrowed or blocked, which reduces blood supply to the brain. This can be caused by a blood clot or build-up of fatty deposits in the blood vessel.

 

2. Haemorrhagic Stroke: Burst Artery

This occurs when a blood vessel in the brain bursts and bleeds. This prevents oxygen and nutrients from reaching brain cells beyond the burst blood vessel, causing them to die.

  

​The risk of having a stroke increases with age, but stroke can happen at any age.
Around 1 in 4 stroke occurs in Singaporeans below the age of 60 years.

• High blood pressure
• High cholesterol
• Diabetes 
• Smoking
• Irregular heartbeat (arrhythmia)
• Previous stroke or heart attack
• Family history of stroke

​​80 percent of strokes can be prevented through lifestyle changes and good control of underlying medical conditions such as high blood pressure, high cholesterol and diabetes.

• ​Go for regular health screening to check for high blood pressure, high cholesterol and diabetes.
• If you have any of these conditions take the medication if prescribed by your doctor and make healthy changes to your lifestyle.
• Quit smoking (if you smoke).
• Get active – aim for at least 150 minutes of moderate intensity exercise every week.
• Eat a healthy balanced diet with at least 4 servings of fruit and vegetable every day.
• ​Avoid excess alcohol.

If you are suspected of having a stroke, you will be assessed urgently at the Emergency Department.
You will have a Computed Tomography (CT) scan to identify the type of stroke, the location and its severity. Blood tests will also be done to help evaluate other causes of your symptoms and guide treatment, e.g. blood sugar levels, cholesterol and how quickly the blood clots.

Some patients may require additional tests to identify the cause of the stroke or to assist with treatment, for example:

1. Angiogram

An angiogram is an advanced x-ray of the blood vessels. It is done by inserting a small flexible tube through the blood vessels up to the brain. Dye is then delivered into the blood vessels of the brain, making them visible on the X-ray for easier identification of the location and severity of the stroke.

2. ​Electrocardiogram (ECG)

An electrocardiogram (ECG) records the electrical activity in the heart. It can detect underlying heart conditions that may have led to the stroke, such as previous heart attacks or irregular heartbeats (arrhythmia).

3. Carotid ultrasound

The carotid arteries are located on either side of the neck and supply the brain with oxygen and nutrients. A carotid ultrasound uses sound waves to assess the blood flow in the neck and check for narrowing or blockages in the carotid arteries.

Treatment is tailored to each patient and depends on several factors including the type of stroke, location, when it occurred, the extent of the damage and if the patient has other health problems.

Nearly all stroke survivors require months of rehabilitation, which can last up to months, to maximise their recovery so they can live as independently as possible. Long-term treatment focuses on reducing the risk of another stroke, through medication and lifestyle changes such as exercise, smoking cessation and controlling high blood pressure, high cholesterol and diabetes.

Ischaemic Stroke

When appropriate, suitable patients who present early from stroke discovery may undergo treatment to remove the blockage and restore blood flow to the brain. This can be done via medication to dissolve the clot or a procedure to remove it. Blood thinners are commonly prescribed to reduce the risk of another stroke. 

Haemorrhagic Stroke

Treatment focuses on controlling blood loss and reducing pressure in the brain caused by the bleeding. This may involve a procedure or surgery and medication.

Recovering from stroke can be a long journey that affects both the stroke survivor and their family members.
Talking to people who have personally experienced a stroke and understand the challenges can help.
These​ organisations provide support, information and activities for stroke survivors and their caregivers:

Singapore National Stroke Association
www.snsa.org.sg
Email: contact@snsa.org.sg
Tel: 6222 9514

S3 - Stroke Support Station
www.S3.org.sg
Email: info@s3.org.sg
Tel: 6473 3500 (Mon to Fri, 9.00am to 5.00pm)

1. ​​Stroke Hub​​​
   

   A resource guid​e for stroke survivors, their loved ones and caregivers. Find out how to spot the warning signs and symptoms of a stroke. Learn how you can support patients in seeking treatment and recovery from stroke.
   
   https://www.healthhub.sg/strokehub