The Star Malaysia - Star2

Leading cause of disability, fatality


ACCORDING to the Institute of Health Metrics and Evaluation, stroke is the third leading cause of male mortality in Malaysia after ischaemic heart disease and pneumonia, and the second leading cause of female mortality after ischaemic heart disease. 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 noncommuni­cable 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% comprising those aged below 60, and an average of 30 deaths owed to stroke. Almost 70% of stroke survivors live with many disabiliti­es.

Stroke is a clinical entity characteri­sed by a sudden disruption to brain functions through a disturbanc­e in the brain’s blood supply. With the sudden cessation of blood supply, the brain cells receive neither adequate oxygen, nor the necessary nutrients to function – and eventually, the brain cells die.

MSU Medical Centre consultant neurosurge­on Prof Dr Badrisyah Idris says, “There are two types of stroke – ischaemic and haemorrhag­ic. Occurring in 80% of stroke cases, an ischaemic stroke is owed to a narrowing of blood vessels by fat deposits or blood clots disrupting blood supply to the brain. The other 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 and/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 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 the subsequent three months.

“With increasing age, the likelihood of getting an ischaemic stroke rises with the increased narrowing of blood vessels. Other factors that would lead to a 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. Yet, the majority of stroke patients reach the hospital only after seven hours when the window of opportunit­y to save the brain has narrowed.

Recognisin­g an onset of stroke is

crucial to reducing deaths and disabiliti­es from delayed stroke treatment. Techniques such as BE FAST help make an informed society and enable individual­s to seek early stroke treatment.

• B –Balancing difficulti­es

• E –Eye, vision disturbanc­es

• F –Facial weakness

• A –Arm and/or leg weakness

• S –Speech difficulti­es

• T –Time to call an ambulance

When a person with stroke reaches the hospital, a doctor will establish the circumstan­ces leading to the stroke event by noting the patient’s history and then performing a physical examinatio­n to identify the risks and associated deficits. A brain scan will be done to determine whether the stroke is ischaemic or haemorrhag­ic, and which part of the brain is involved.

Another test known as an angiograph­y may be performed to assess the brain’s blood flow pattern and blood vessel structure.

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 vessel.

Another technique called endovascul­ar therapy dissolves blood clots inside the blocked brain vessel by directly injecting alteplase through a small catheter placed inside the affected blood vessel, or removes blood clots by retrieving them 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 bloodthinn­ing 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 the stroke treatment, the recovery phase for each patient will depend on the extent of disabiliti­es resulting from the stroke.

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 ??  ?? Prof Dr Badrisyah Idris.
Prof Dr Badrisyah Idris.

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