Prof Dr Badrisyah Idris Neurosurgeon
ACCORDING to the Institute of Health Metrics and Evaluation, stroke is the third leading cause of male mortality after ischaemic heart disease and pneumonia, and the second leading cause of female mortality after ischaemic heart disease in Malaysia.
The leading cause of mortality worldwide is heart disease, which accounts for 16% of all fatalities. Stroke follows closely, accounting for 11% of deaths. In addition, key contributors to disability and the rise in healthcare costs include heart disease and stroke. Heart disease and stroke share many similarities.
Many major risk factors for heart disease and stroke can be altered by implementing several easy lifestyle adjustments such as exercising, maintaining a healthy weight, abstaining from smoking, eating a heart-healthy diet and controlling your blood pressure.
Stroke is expected to become the second leading cause of mortality by 2040, according to the Global Burden of Disease Report. The increasing trends of non-communicable diseases such as diabetes, hypertension and obesity are posing substantial threats to stroke incidences in Malaysia.
On average, there are about 90 stroke admissions at Malaysian hospitals daily; with 40% of cases comprising patients below 60 years of age, and an average of 30 deaths owed to stroke. Almost 70% of stroke survivors live with many disabilities.
Stroke is characterised by a sudden disruption of brain function due to a disturbance in its blood supply. When the blood supply is abruptly cut off, brain cells are deprived of oxygen and essential nutrients, causing them to malfunction and eventually die.
Medical director and consultant neurosurgeon Prof Dr Badrisyah Idris at MSU
Medical Centre explains, “There are two types of stroke; ischaemic and haemorrhagic. Occurring in 80% of stroke cases, ischaemic stroke is owed to a narrowing of blood vessels by fat deposits or blood clots disrupting the blood supply to the brain. The remaining 20%, owed to ruptured blood vessels, can be caused by uncontrolled high blood pressure or a weakened blood vessel wall.
“Stroke survivors suffer different deficits according to the affected brain area. They may suffer from memory or emotional disturbances, or be challenged by speech, vision, sensory or movement difficulties. In a transient ischaemic attack, commonly called a mini-stroke, the symptoms hit for only a few minutes or hours and then disappear. Mini-strokes happen when the blood supply to the brain is interrupted only momentarily, though the chance of getting a permanent stroke within 48 hours rises tenfold and the risk remains high within three months.”
“With increasing age, the likelihood of getting an ischaemic stroke rises with the increased narrowing of the blood vessels. Other factors leading to stroke include smoking, obesity, alcoholism, high blood pressure, high blood cholesterol, and high blood sugar. Lifestyle changes and treatment optimisation may reduce the risk of getting a stroke.”
Anyone who has had a stroke should receive treatment at a hospital within three hours after the onset of stroke signs to reduce further damage to the brain. The majority of stroke patients arrived at the hospital only after seven hours, narrowing the window of opportunity to save the brain.
Recognising the onset of stroke with tools such as ‘BE FAST’ is crucial to reducing deaths and disabilities from delayed stroke treatment.
• B – Balancing difficulties • E – Eye and vision disturbances
• F – Facial weakness
• A – Arm and/or leg weakness
• S – Speech difficulties
• T – Time to call ambulance
When a person with a stroke reaches the hospital, a doctor will establish the circumstances leading to the stroke event by taking its history and then performing a physical examination to identify the risks and associated deficits. A brain scan will be performed to determine whether the stroke is ischaemic or haemorrhagic and which part of the brain is involved. Another scan or investigation called angiography may be performed to assess the brain’s blood flow pattern and blood vessel structure.
“The leading cause of mortality worldwide is heart disease, which accounts for 16% of all fatalities. Stroke follows closely, accounting for 11% of deaths. In addition, key contributors to disability and the rise in healthcare costs include heart disease and stroke.”
Stroke treatment
Treatment for stroke depends on the stroke type. For ischaemic strokes, restoring blood flow to the affected area is crucial and should be carried out within four hours of the stroke’s onset. This can be done by injecting a blood-thinning medication called alteplase into a vein in the arm to dissolve blood clots inside the brain’s blood vessels.
Another technique called endovascular therapy dissolves the blood clot inside the blocked brain vessel by directly injecting alteplase through a small catheter placed inside the affected blood vessel or removing the blood clot by retrieving it with a special device through a catheter placed inside the affected blood vessel.
For haemorrhagic strokes, the main goal of treatment is to control bleeding and to reduce the increased pressure in the brain. The high blood pressure has to be controlled by antihypertensive drugs, and the effect of the blood-thinning medication has to be reversed to reduce further bleeding. Ruptured blood vessels caused by cerebral aneurysms or arteriovenous malformations need to be treated by surgical intervention or endovascular therapy.
Following stroke treatment, the recovery phase for each stroke patient will depend on the extent of disabilities resulting from the stroke. Most stroke patients need to undergo physical therapy to regain limb functions or prevent severe limb spasticity. Some may also need speech therapy to improve their ability to speak and understand conversations.
By Prof Dr Badrisya Idris
Better access for stroke patients, and Helping stroke survivors in a pandemic
What is the Blood-Brain Barrier?
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