Stroke – The 3rd Leading Cause of Death and What Can You Do About It

By Island Hospital   |   06.12.2018

On a family vacation in Bogor, Jonathan*, 52, suffered a massive stroke but refused to be taken to the hospital by his wife only until much too late. The next few days were filled with hospital arrangements, consultations with doctors there, and the logistics of getting him home which weighed down on his wife. She had a business to run, 4 children below 19 years old, and not much time to think about the longer-term implications of Jonathan’s stroke. This process of adjusting to a new way of life to cater for Jonathan’s needs only kicked start after they went back to Jakarta, where he spent a month in the hospital and then three months at the rehabilitation centre. He had lost all ability to speak, write, or even gesture to show his needs.

There are many stories like that on our stroke patients. Time is of great importance when it comes to stroke.

*not his actual name

Stroke is a devastating illness resulting in death or significant disabilities in survivors and it is the 3rd leading cause of death in many countries.

Stroke is a disruption of brain function caused by blocked blood vessels or bleeding in the brain (bleeding in the brain, caused by trauma, like from an injury, is not considered a stroke).

Stroke results in symptoms such as:

  • weakness or numbness in one or more limbs
  • a droop on 1 side of the face
  • difficulty lifting 1 arm to its full height
  • slurred speech or inability to speak / understand
  • visual disturbance (seeing double, sudden blindness in one eye),
  • vertigo 
  • unsteady gait or difficulty walking
  • unconsciousness and may result in death

However, bear in mind that there may be other symptoms as well.

The risk of stroke is higher in:

  • males,
  • older adults. and
  • certain genetic constituents (race)

The risk of developing a stroke may be reduced significantly by:

  • lifestyle modification,
  • appropriate medication and in some cases,
  • surgery (of selected neck arteries leading to the brain).

There are, however, many modifiable risk factors; favourably modifying these risk factors reduces the chance of suffering a stroke.

Such modification includes proper control (if present) of:

  • hypertension (persistent high blood pressure),
  • diabetes mellitus (high blood sugar levels over a prolonged period),
  • high blood lipids (high level of LDL (low-density lipoprotein) cholesterol and/or triglycerides)
  • smoking, and
  • low level of physical activities

Consumption of specific drugs which inhibit ease of blood clot formation like aspirin, clopidogrel or warfarin has been proven to reduce stroke incidence and recurrence in appropriately selected patients. These drugs may have risks and should only be used under the supervision of a doctor. There are also newer drugs now, to ease the symptoms.

Do the FAST test and note the time when you see these symptoms 1-3.

  1. FACE: Ask the person to smile. Does one side of the face droop?
  2. ARMS: Ask the person to raise both arms. Does one arm drift downward?
  3. SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
  4. TIME: If you observe any of these signs, call Hospital Emergency Hotline

Even if symptoms vanish quickly, call for help

Warning signs may last only for a few minutes before they disappear. These brief episodes are transient ischemic attacks (TIA) or “mini-strokes.” They still should be taken seriously, because they tend to be signs of underlying serious conditions and those with TIA are definitely at higher risk of having a subsequent stroke, and they need to be checked and managed by a doctor.

First Step: Diagnosis

The first step in the correct management of a patient with suspected stroke is to get the diagnosis correct. This will involve the doctor examining the patient and possible further tests like:

  • blood evaluation,
  • a chest X-ray, and
  • brain scan - CT (computerized tomographic) scan or MRI (magnetic resonance imaging).

The initial diagnosis of stroke by the attending doctor is often a clinical diagnosis supported by brain scan findings (ideally a cranial MRI).

Next Steps: Treatment and Rehabilitation

Once the diagnosis of stroke is determined, treatment in the early initial stage often requires hospital admission. Time is of the essence. “Clot busters” (in the form of “tPA” - tissue plasminogen activator) may be used to treat stroke if the cause of stroke is a blocked blood vessel in the brain and the patient’s scenario satisfies stringent criteria including initiation of treatment within 4.5 hours of first symptoms of stroke. This treatment is not without risk, and in general, only a minority of all ischaemic stroke patients will qualify for such treatment.

If the stroke is due to the bleeding in the brain, the cause, often being hypertension and less often rupture of abnormal blood vessels in the brain that the patient is born with, effective treatment involves appropriate control of blood pressure and possible surgical evacuation of the blood clot (or other neurosurgical procedures as determined on a case-by-case need).

Besides treatment with drugs and by surgery, the treatment of stroke involves proper rehabilitation, including physiotherapy, occupational therapy and speech therapy (in patients with speech disruption caused by the stroke.) Helping the patient and family, care-givers, and loved ones to understand and cope with the “calamity” of stroke is equally important.

Jonathan’s wife wished that she had insisted (against his wish) to get him treated before it was this late.

Through the encouragement of his doctor, caregivers and family, Jonathan stepped out of depression from such a debilitating disease and gained strength to adhere to his treatment plan and saw progress. However, it is true for a stroke patient like Jonathan and his family, life will never be the same again.

Jonathan went on to regain some speech function’ over the years which was a big comfort to his family.

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