Knowing Stroke, Acting F.A.S.T

Stroke attacks the brain, the central human control for all bodily functions. When it happens, it changes your life in an instant and could possibly disable you permanently.

Dr. Manish Taneja, an Interventional Radiologist at Farrer Park Hospital says that a stroke is the leading cause of adult disability and the fourth leading cause of death in Singapore[1]. But catching it early can make a significant difference.

The Incidence of Stroke

Worldwide statistics have shown that there were some 13.7 new million stroke cases in 2016[2] with 5.5 million of these cases resulting in deaths.

In Singapore, there were more than 8,000 cases of acute stroke in 20181. About 70 to 80 percent of stroke are ischemic stroke. It is caused by blockage of a blood vessel, limiting blood flow to the brain. The other common type is hemorrhagic stroke or bleeding into the brain. The condition can be caused by brain aneurysm, a condition seen in younger patients, age between 40 to 60 years of age. Brain aneurysm happens when the weakened artery wall bulge and rupture, causing the bleed.

According to the Singapore Stroke Registry Report 2018, the median age of a hemorrhagic stroke patient is 66 years old and while the median age of an Ischemic stroke patient is 69 years old. With a rapidly aging population, it is worrying the incidence of stroke will rise.

Asked about the general rate of recovery for stroke patients who are in their 50s and 60s and those who are younger, Dr. Manish said: “In general, one third recover, one third partially recover, one third do not recover. Younger patients have better recovery rates and outcomes.”

Spot a Stroke F.A.S.T.

The common symptoms of a stroke are the drooping of a side of your face, weakening of one of your arms and speech difficulty; occurring often on the right side. But when these symptoms appear, it should already be an emergency.  

Aneurysms often go undetected until there is a rupture and bleeding. When this happens, the common symptoms may include nausea and vomiting, stiff neck, blurred or double vision, sensitivity to light, seizure, drooping eyelid or sometimes, nothing more than a sudden severe headache.

“The peak age of rupture is between 40 to 60 years of age and about 20 to 30 percent of this population will have multiple aneurysms,” Dr. Manish says. However, stroke devices and surgical procedures for aneurysms too have come a long way.

“Interventions for acute stroke have rapidly evolved over the last 10 to 15 years. Newer technology and newer imaging techniques have translated into better outcome for patients and further advances are expected over the next few years,” he explains.

Beating the Clock

In addition to physical disability, stroke can cause cognitive impairment like dementia. It is no wonder that Dr. Manish Taneja emphasizes that time is the essence.

“Things have moved along in how we treat patients who are suspected of a stroke since the 1990s. Today the worldwide standard is to treat stroke emergencies like a heart attack,” says Dr. Manish. It must be attended to as soon as possible or ideally, within 8 hours of the stroke onset.

“The estimated brain cell loss in a stroke patient per minute equates to an accelerated aging of 3.1 weeks. In every hour, that’s 3.6 years. And every stroke, 36 years,” he explains. 

Citing the New England Journal of Medicine in clinical practice, Dr. Manish said as a baseline, the time of a stroke onset is determined as the time that the patient was last known to be well. Treatment is guided from the onset, severity of the neurological deficit and findings on neuroimaging.

“MRIs have also come a long way since the 90s. We know what imaging techniques are better at treating and diagnosing a stroke as well. And the average risk for clot retrieval is about 1 to 2 percent now so it is a very safe procedure,” he noted.

Possible surgical interventions for an acute ischemic stroke can include, IA thrombolysis; Clot retrieval; Carotid stenting; Intracranial Stenting; Aneurysm; coiling/clipping; Hematoma Evacuation; or Decompression Craniotomy. This is coupled with medical interventions such as, prescribing aspirin or a clot-busting drug, if you are eligible for it, aims to disperse the clot and return the blood supply to your brain as well as rehabilitation and nursing care.

And he noted: “The success rate for stenting interventions is more than 90 percent in my experience with complete or near complete opening of the vessel now.”

Reducing Stroke Factors

“An active, healthy lifestyle with body weight in normal range. Regular screening for risk factors such as hypertension, diabetes, cholesterol, not smoking and getting a thorough check for stroke symptoms or signs if there is a family history, are all important.”

As identified by the Singapore Stroke Registry Report 2018[3], several common factors reinforced his advice. Across the 8,326 local cases, 82 percent had high blood pressure and 84 percent had high cholesterol. There were also 43 percent with diabetes, and 36 percent were smokers. Moreover, 21 percent of the patients had atrial fibrillation or flutter, a heart rhythm disorder which causes the heart to beat much faster than usual.

As the world faces the question of an aging population, Dr. Manish says that knowing what your risk of a stroke are, is compulsory.

[1] Chong, C. (2020, October 19). More stroke cases in s’pore in 2018: How do I prevent stroke and what should I look out for? The Straits Times. Retrieved November 3, 2021, from https://www.straitstimes.com/singapore/how-do-i-prevent-stroke-and-what-should-i-look-out-for.

[2] Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. (2019, March 11). Retrieved November 3, 2021, from https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(19)30034-1/fulltext.

[3] Singapore Stroke Registry Annual Report 2018 – NRDO. (n.d.). Retrieved November 3, 2021, from https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/ssr-web-report-2018.pdf?sfvrsn=58eb7c4c_0.

This Article Was Reviewed By:

Dr. Manish Taneja is an expert in performing minimally invasive interventional procedures under image guidance. He is also a proctor who supports procedures and operations in other countries in the region independently.
Dr. Manish did his initial medical training in Delhi, India. He subsequently moved to the U.K. where he specialized in Radiology with an interest in Interventional Radiology. He obtained his FRCR & CCST (Certificate of Completion of Specialist Training) from the UK.
Dr. Manish has two interventional fellowships in body and neuro-intervention of one year each from University of Toronto, Canada & University of Washington, Seattle, USA.

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