What is a stroke What causes a stroke Who is at risk What are the symptoms How stroke is diagnosed What

What are the effects of stroke What can be done to reduce the risk of stroke Reducing the risk of subsequent stroke

Stroke is the third largest cause of death in Malaysia. Only heart diseases and cancer kill more. It is considered to be the single most common cause of severe disability, and every year, an estimated 40,000 people in Malaysia suffer from stroke. Anyone can have a stroke, including children, but the vast majority of the cases affect adults.

Functions of the brain

A stroke is a brain attack and occurs when the blood supply to the brain is disrupted. One side of your body may be paralyzed, your behavior, thought and memory patterns are altered.

 Mini stroke

The symptoms are very similar to a full stroke but unlike a full-blown stroke, the symptoms last under 24 hours and afterwards there is full recovery. A TIA is an indication that part of the brain in not getting enough blood and that there is a risk of a stroke occurring. A TIA should never be ignored .

Ischaemic stroke :
A cerebral thrombosis. A cerebral embolism. A lacunar stroke

A blood clots get stuck in an artery and blocks the blood flow.

Areas of the brain affected with stroke ( circled red circles)

MR angiography showing blockage of the artery in the brain (arrow)

Haemorrhagic stroke :
An intracerebral haemorrhage. A subarachnoid haemorrhage.
When an artery bursts blood is forced into the brain tissue, damaging cells so that area of the brain can't function.

Prevention continuum

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3. 4. 5.

6.
7.

8.

Untreated high blood pressure (hypertension). This damages the walls of the arteries. Diet. A diet high in salt is linked to high blood pressure, while a diet high in fatty, sugary foods is linked to furring and narrowing of the arteries. Diabetes. People with diabetes are more likely to have high blood pressure and atherosclerosis, and so are at much higher of stroke. A previous TIA. Around one in five people who have a first full stroke have had one or more previous TIAs. Atrial fibrillation. This type of irregular heartbeat increases the risk of blood clots forming in the heart, which may then dislodge and travel to the brain. Smoking. This has a number of adverse effects on the arteries and is linked to higher blood pressure. Regular heavy drinking. Over time this raises blood pressures, while an alcohol binge can raise blood pressure to dangerously high levels and may trigger a burst blood vessel in the brain. Certain types of oral contraceptive pill. These can make the blood stickier and more likely to clot. They may also raise blood pressure.

Age. Strokes are more common in people over 55, and the incidence continues to rise with age. Gender. Men are at a higher risk of stroke than women, especially under the age of 65. Family history. Having a close relative with a stroke increases the risk, possibly because factors such as high blood pressure and diabetes tend to run in families.

 Sudden weakness or numbness on one side of the body. Signs of this may be a drooping face, a dribbling mouth, weakness in the arm or leg. Sudden blurred vision of one eye or both eyes.

Difficulty in speaking or understanding speech, or slurred speech.

Dizziness, loss of balance, confusion

Sudden severe headache

Nausea or vomiting

Blood pressure measurement. Blood tests to check blood sugar, clotting and cholesterol
levels.

Chest X-ray to check for heart or chest problems.

An electrocardiogram and activity of the heart.

(ECG) to measure the rhythm

An echocargiogram, a type of heart scan, to check for heart problems.

for signs of damage.

Brain scans to determine the type of stroke and to look

An ultrasound scan of the carotid arteries to check blood flow to the brain.

Loss of movement or abnormal movement patterns on one side of the body (hemiplegia). Because the right side of the brain controls the left side of the body (and vice versa), hemiplegia occurs on the opposite side of the body where the stroke occurred. Poor coordination. Abnormal posture. Difficulty with speaking and understanding, and with reading and writing. Incontinence. Partial loss of vision. Inability to swallow.

Becoming cautious, anxious and disorganized. Easily depressed, inability to control emotion. Poor concentration in learning new skills. Inability to understand speech.

Inability to judge distance, size, position. Loss of feeling in one side of the body. Loss of body image.

Regular exercise. Find out if you have high cholesterol. Eat a low-salt, low-fat diet. Stay a healthy weight. Don't smoke. Drink sensibly. Get your blood pressure checked. Diabetes- follow your physician's recommendations to control the condition. Seek advice from your doctor before taking contraceptive pill or going for HRT. Ask your physician if you have circulation problems that could increase the risk of stroke. Seek immediate medical attention if you experience any stroke symptoms, including sudden weakness of the face or a limb, a blurring of vision, dizziness, or an intense headache

Lower blood pressure

Reduce the risk of blood clots Lower bad cholesterol levels

Diuretics rid the body of excess fluids and salt (sodium) Beta-blockers reduce the heart rate and the heart's output of blood Sympathetic nerve inhibitors sympathetic nerves go from the brain to all parts of the body, including the arteries. They can cause arteries to constrict, raising blood pressure. This class of drugs reduces blood pressure by inhibiting these nerves from constricting blood vessels. Vasodilators these can cause the muscle in the walls of the blood vessels to relax, allowing the vessel to widen. Angiotensin-converting enzyme (ACE) inhibitors these interfere with the body's production of angiotensin, a chemical that causes the arteries to constrict. Angiotensin II receptor blockers block the effects of angiotensin. Calcium antagonists can reduce the heart rate and relax blood vessels.

Asperin Ticlopidine Clopidogrel,

Wafarin

materials taken from : HSC medical center ( www.hsc.com.my) National stroke association of Malaysia NASAM( www.nasam.org )

Presented by Dr. Mohana Krishna