SUNDAY STAR, 28 OCTOBER 2018

STROKE AWARENESS

Help at hand
Life after stroke is not easy, be it for the survivor or his family.
Rehabilitation is part of the treatment for stroke and professionals
can help survivors regain control of their lives.
2 Stroke Awareness
Story of Judy Lee
Judy Lee (pic) suffered an ischaemic
stroke two years ago in August. The
blood clot in her left brain left her face
distorted, speech hampered and right
limbs unable to move.
Lee’s stroke was caused by high
blood pressure and uncontrolled
cholesterol. Without consulting a doctor,
she stopped taking her medication once
her pressure and cholesterol were under
control, a move that eventually led to
her stroke.
“I was having a cup of Milo in the
morning, before leaving for a family
fun day with my sister, brother-in-law
and grandniece, when I felt my
drink dripping from the side of my
mouth.
“My grandniece noticed it too and my
speech slurred when I tried to talk to
her. I somehow managed to
communicate to my grandniece to call
her grandma and granddad.
“My family took one look at me
and knew there was something wrong
since a side of my face had drooped.
They rushed me to the hospital
where I was told that I had suffered a
stroke.
“I was completely ignorant about
stroke before it happened to me. I did
not even know what it was and how it
was caused.
“It took me a long time to accept what
happened and I was depressed about my
condition. My friend talked me into
going for rehabilitation and that was the
turning point for me.
“I started getting better with
rehabilitation. Now after two years I can
speak, although I take a little more time
to say certain words.
“I am now working on being able to
move my right limbs with the help of
physiotherapy and am thankful to my
friends and family for
supporting me throughout
this journey.”
Lee’s advice to people with risk
factors for stroke is to make undergoing
regular health check-ups a priority.
Zest for life
By SRIMAYEE SEN SARMA
JUDY Lee and Maria Othman, two
gregarious stroke survivors who are
currently undergoing rehabilitation, instil
hope in the hearts of other survivors and
their loved ones.
Not ones to be bogged down by a tragedy,
they decided to get right back up, in the
process inspiring other stroke survivors to
do the same.
While the experiences and journey from
stroke to recovery are very different for Lee function. This is what is
and Maria, they were unanimous in
emphasising the two most important factors
that helped them get back up – support and
rehabilitation.
According to both women, the one
positive effect that stroke has had in their
lives is realising how loved they are and the
extent of human kindness.
A friend of Lee’s volunteered to
pay off her existing loans, and Maria’s
friends flew from Japan, Thailand and the
Philippines to visit her. The love,
understanding, care and support that they
received were the greatest motivating
factors that helped them regain their
confidence and zest for life.
National Stroke Association of Malaysia
(Nasam) communications coordinator
Vanaja Dhanan stresses the importance of
friends and family in the rehabilitation of
stroke survivors.
She says, “Support from loved ones has a
major role to play in boosting the morale of
a stroke survivor, because willingness is the removing the blood clot or stopping the
first step to recovery.
“Imagine not being able to walk, talk
and do all the other things that we
usually take for granted. This inability
causes depression in stroke survivors.
In such scenarios, care from loved ones
is imperative in inspiring them to
move forward and fight against these
disabilities.
“Stroke survivors are more motivated to
undergo rehabilitation when they have
encouragement from friends and family.
We have seen what wonders this drive can
do in bringing back functionality faster and
more effectively.”
Stroke affects not just the patient as it
also shakes up the circumstances and
Story of Maria Othman
Unlike Judy Lee, stroke survivor Maria
Othman (pic) did not have any risk
factor. What she did have was a ruptured
aneurysm.
Aneurysm is the ballooning of a vessel
that carries blood to the brain, which can
burst and cause a stroke.
According to Dr N. Ramesh
Narenthiranathan, consultant
neurosurgeon at Ara Damansara Medical
Centre, “Although aneurysms are
believed to be congenital, they can also
develop with time.”
The only way to diagnose an
aneurysm, congenital or otherwise,
is through a professional
health check-up since
unruptured aneurysms
oftentimes have no clear
symptoms, making
aneurysm unpredictable
and dangerous.
Maria narrates her story:
“I was working late into the
night and all I remember
was suddenly
collapsing on top of
my husband. I did
not have any other
stroke symptoms
such as drooping
of face or
slurring of
speech.
“I was only
vaguely
conscious of
SUNDAY STAR, 28 OCTOBER 2018
The unaffected
brain needs to be
trained by doing a task
over and over. This allows
it to rewire itself to learn
and take over this new
essentially done in stroke
rehabilitation – making
the stroke survivor
perform repetitive
tasks.
Dr Ramesh Narenthiranathan
people in her life. However, with a little
understanding and patience from loved
ones, in addition to timely treatment and
proper rehabilitation, stroke survivors can
successfully take back control of their lives.
Maria and Lee, along with many other
stroke survivors, are testament to this.
Regaining control
Stroke treatment does not end with
haemorrhage. Rehabilitation is a vital part
of treatment.
“The final goal of doctors in treating
stroke patients is not saving lives but
bringing back functionality. The only way to
bring back this functionality is to start
rehabilitation as soon as possible,” says
Dr Ramesh Narenthiranathan, consultant
neurosurgeon at Ara Damansara Medical
Centre.
Many hospitals in Malaysia begin the
process of inhouse rehabilitation as soon as
a patient is declared medically fit by the
doctor. It is up to the patient and his family
to continue with it afterwards.
> SEE NEXT PAGE
getting to the hospital and speaking
incoherently to my husband about the
pain in my head. I didn’t know what had
happened to me when I regained my full
consciousness. Because I could not feel
my legs, I thought I was in an accident
and that my legs had been amputated.
“For a long time, I did not accept what
happened to me since I was healthy one
day and could not even sit up without
help the next.
“I was angry initially but eventually
accepted what had happened. With this
acceptance and the help of rehabilitation
at the National Stroke Association of
Malaysia, I gained back my positive
outlook and also some of my
functionality.”
While Maria could still speak, she
lost her ability to move or even sit.
Rehabilitation has helped Maria regain
her strength so she can not only sit but
move around in a wheelchair and walk
a few steps with help.
An expert diver, dancer and
enthusiastic traveller, Maria
remains positive about her
second shot at life.
“I am 59 years young
since I am learning
everything again like a
small baby. I am still
alive, and I want to
make use of it. I have
hopes that I will be able
to go diving again
someday.”
SUNDAY STAR, 28 OCTOBER 2018
Regaining hope for the future
> FROM PREVIOUS PAGE
Tracy Chan, head of rehabilitation at
Nasam, explains the importance of starting
rehabilitation early: “The target is to prevent
secondary complications that may occur
after a stroke and rewire the brain to speed
up recovery.
“The longer the duration between stroke
and rehabilitation, the weaker and tighter
the muscles will get, and they would also be
deconditioned, making the recovery of
functionality more difficult.”
With timely rehabilitation, neuroplasticity
kicks in. Dr Ramesh elucidates,
“Neuroplasticity is training the unaffected
part of the brain to take over the functions of
the affected part.”
According to him, neuroplasticity is the
same as training the brain of a child. “The
unaffected brain needs to be trained by
doing a task over and over. This allows it
to rewire itself to learn and take over this
Story of Ronnie Ding
new function.
“This is what is essentially done in stroke
rehabilitation – making the stroke survivor
perform repetitive tasks,” he adds.
Chan says, “It takes time to see the results
of rehabilitation. Initially, it can be
frustrating for the stroke survivor as well as
the caregivers.
“It is, however, important to have
patience. Yes, progress may be slow, but
however little, there is still progress and it is
important to cheer them on for every little
accomplishment and motivate them to fight
harder.”
Experiencing a stroke is not the end
of the world. With a little patience and a
lot of support from loved ones, stroke
survivors can bounce back to living their
lives.
In line with the theme for this year’s
World Stroke Day – Up Again After Stroke – it
is crucial that every stroke survivor gets a
second chance at life.
Stroke Awareness 3
Ronnie Ding, husband and full-time “Talk to people who understand when
caregiver of stroke survivor Maria it becomes too much to handle, but make
Othman, shares his experience of sure you do not lose your positivity
supporting a stroke survivor while coping because motivation and support have an
with the ordeal himself: amazing effect on the outcome of
“I thank God that Maria fell on me rehabilitation for stroke survivors.”
instead of falling to the other side of the
bed. I woke up and knew instantly that
something was wrong because even
though she could speak, she seemed Ding (standing) with Maria.
confused and could not open her eyes. I
immediately took her to the emergency
room.
“Initially, the doctors could not
understand what was wrong since there
were no external telltale signs of stroke.
However, some quick scans and tests
revealed that she had suffered a
haemorrhagic stroke caused by
aneurysm.
“She was released from the hospital
within a few days. Initially, she was very
negative, angry and frustrated with her
condition.
“It was depressing for me to see her
like that because I didn’t know how to
help her. Slowly, with rehabilitation and
counselling, she started to become more
positive, especially when she started
regaining her functionality.
“On the other hand, I started becoming
more confident with my role as the
caregiver after meeting therapists and
other stroke survivors at the National
Stroke Association of Malaysia.”
Advising caregivers of stroke patients
to be understanding above everything
else, Ding adds, “With understanding
comes patience, and you would need to
garner all your patience when dealing
with a stroke survivor.
“You must understand that they are not
themselves anymore and are helpless in
what they are doing or not doing.
4 Stroke Awareness
Helping you make time for fitness
WE know that maintaining an active
lifestyle should be one of our top priorities
in life. Being fit can reduce your risk of
stroke, help with your brain health and
memory, improve sleep quality and relieve
stress.
Finding time to work out when you are
busy can sometimes feel impossible.
However, you do not need an hour to get a
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postures.
If you prefer to cycle while watching your
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On the gadget holder, you can place your
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With a hectic schedule, it is easy to lose
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regarding your fitness. The FC Pro Desk Bike
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You can purchase the FC Pro Desk Bike at
instalments of RM124.17 over 12 months at
Understanding the
subtle differences
ISCHAEMIC stroke and haemorrhagic stroke
happen independently of each other.
Although both types of stroke share the same
Ischaemic stroke
Blood clots
l Ischaemic stroke occurs when there is a
blockage in the blood vessels that supply
blood to the brain.
More common
l According to the American Heart
Association, ischaemic stroke accounts for
87% of all strokes.
Higher survival rate
l While more common, ischaemic strokes
generally have a slightly higher survival
rate than haemorrhagic stroke.
Treatment
l During the first four hours of stroke,
patients can be given emergency
thrombolytic therapy medication to
dissolve the blood clot in the brain.
l In the four- to six-hour window of
occurrence, a mechanical thrombectomy
procedure can be done to remove the clot
from the brain.
l Between six and 24 hours, mechanical
thrombectomy can be carried out if the
patient’s condition is eligible for it.
l General cases can also be treated with
blood thinner to dissolve the clot in the
brain.
SUNDAY STAR, 28 OCTOBER 2018
The FC Pro Desk Bike
can increase your work
productivity while you
get your exercise done at
home or work. If you are
wondering how this is
possible, the FC Pro Desk
Bike is equipped with
many interesting features
to keep you healthy and
fit even with your busy
schedule.
any Fitness Concept store.
By spending between RM1,000 and
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risk factors and methods of prevention, they
are different in their manifestation and
treatment requirement.
Haemorrhagic stroke
Bursting and bleeding of blood vessel
l Haemorrhagic stroke occurs when a
weakened blood vessel ruptures, causing
the vessel to bleed. Sometimes, blood
clots will start to form on the outside of
the blood vessel.
Less common
l Haemorrhagic stroke makes up 13% of
all stroke cases.
Lower survival rate
l Due to the rupture of blood vessels,
haemorrhagic stroke is more critical than
ischaemic stroke, lowering its rate of
survival.
Treatment
l As haemorrhagic stroke is more lethal,
emergency treatment must be done to
control the bleeding and pressure exerted
by bleeding in the brain. Drugs will be
given to the patient to lower blood
pressure and slow blood flow to contain
the situation.
l Depending on the condition of the
patient, surgery may be required to repair
the rupture or remove the blood clot
formed in the brain.
SUNDAY STAR, 28 OCTOBER 2018 5
6 Stroke Awareness
MANY people have this idea that a
stroke does not come with any
warning and can strike anyone at
any time.
According to Dr Lee Yik Yong,
consultant internal medicine
physician at Columbia Asia
Hospital – Petaling Jaya, this is only
partially true.
“In some people, there are no
symptoms before a sudden attack
of stroke, but in some others, there
are warning signs in the form of
minor strokes known as transient
ischaemic attack (TIA), which
precedes a full-blown stroke,” he
says.
“These mini strokes have similar
indications of a full-blown stroke,
such as numbness or a tingling
sensation on one or both limbs on
one side, dizziness and speech
incoherency, but these symptoms
do not last for long.”
Dr Lee warns that TIA should
not be ignored since people who
have had a mini stroke are at a
higher risk of getting a full-blown
stroke later in life.
The indicators
To identify whether a person is
having a full-fledged stroke, Dr Lee
points out the following symptoms
to look out for:
l Sudden numbness in the arm,
leg or face, especially on one side
STROKE is ranked as the second
most common cause of death in the
world and third most common
cause of disability-adjusted life
years, according to a 2010 study
titled Global Burden of Disease,
Injuries and Risk Factors.
The effect of stroke on a person
depends on the area of his brain
affected by the stroke. Some
patients may become hemiplegic
with some loss of sensation while
others may lose the ability to
comprehend speech or express
themselves.
Stroke can be mild in that it may
cause minimal weakness, affecting
only the hand, or it can be severe,
causing profound disability or even
death. The main types of
disabilities that a stroke can cause
are:
l Paralysis
l Sensory loss
l Communication difficulties –
inability to talk/express oneself,
understand speech or both
l Difficulties in thought
processes
l Memory problems
Rehabilitation is an important
part of recovery after stroke. There
is currently no medication that has
shown good evidence of reversing
disability from stroke. The goal of
rehabilitation is to help the patient
relearn skills lost due to stroke.
Research has shown that
participating in a focused stroke
rehabilitation programme helps
patients perform better than those
A comfortable bedroom at KPJ Tawakkal Health Centre's RILU.
Recognising the signs
of the body
l Slurring of speech, confusion,
sudden inability to understand
l Sudden loss of vision in one or
both eyes or blurring of vision
l Severe headache, dizziness or
loss of consciousness, imbalance,
loss of coordination
If such signs are noticed in
a person, it is important to
get medical help immediately.
Otherwise, it might turn fatal.
Dr Lee informs, “Strokes are
mainly of two kinds – ischaemic
and bleeding or haemorrhagic.
Ischaemic stroke happens when
there is a blood clot in the brain
that cuts off oxygen supply to a
part of the brain and the part
slowly dies off.
“Haemorrhagic stroke occurs
when one or a few of the blood
vessels in the brain burst and
blood floods in. Haemorrhagic
stroke is more common in people
with uncontrolled hypertension.”
Seeking treatment
Treatment differs for the two
kinds of stroke. “For ischaemic
Stroke rehabilitation programmes
who do not. The type of
rehabilitation programme depends
on:
l The disability caused by the
stroke
l The severity of the stroke
KPJ Tawakkal Health Centre’s RILUs have spacious, wheelchair-friendly living and dining/cooking areas.
l Other medical problems the
stroke patient has
l Family and community
support
Stroke rehabilitation is best
carried out by a multidisciplinary
team of health professionals such
as physiotherapists, occupational
therapists and speech therapists
under the leadership of doctors
trained in rehabilitative medicine.
stroke, the blood clot needs to be
dissolved, which can be done with
the help of medication.
“As for haemorrhagic strokes,
blood pressure needs to be reduced
first to control the bleeding before
brain surgery is performed to
repair the damaged blood vessels,”
he explains.
According to Dr Lee, while
mortality rate is higher with
haemorrhagic stroke compared to
Stroke rehabilitation works best
when the patient, family and
rehabilitation team work together.
There should be achievable goals
decided mainly by the patient and
his family with guidance from the
team.
The therapy is then designed to
meet these goals, which are
reviewed regularly by the team,
patient and his family to ensure
the goals are met and readjusted if
not, and make new goals. There
should be an agreed time frame for
these goals. Hence, each
programme is individualised to
meet each person’s specific needs.
Some general treatment
components include:
l Treating complications of
stroke such as spasticity, difficulty
swallowing, pressure sores and
pain
l Improving a person’s function
in terms of self-care and ability to
perform housework and his work
l Providing adaptive equipment
and ensuring the environment is
safe such as installing grab bars for
the toilet and shower chairs in the
bathroom.
Stroke rehabilitation should be
started as soon as possible
Haemorrhagic
stroke occurs when
one or a few of
the blood vessels
in the brain burst
and blood floods
in. Haemorrhagic
stroke is more
common in people
with uncontrolled
hypertension.
Dr Lee Yik Yong
ischaemic stroke, the latter has a
higher rate of occurrence.
Regarding the recovery
prospects of strokes, he says,
“Recovery depends on the extent of
the stroke. For mild to moderate
strokes, recovery within six
following acute medical care to
stabilise the patient. It is then
continued as inpatient treatment
until the patient is stable enough to
go home.
The patient can then be
transferred as an inpatient to a
rehabilitation hospital or
outpatient at a rehabilitation
centre such as the KPJ Tawakkal
Health Centre.
A rehabilitation centre would
have the expertise and the
necessary equipment to enable the
patient to become as independent
as possible. The centre has Rehab
Independent Living Units (RILUs)
where patients can be trained to be
independent in a homelike setting.
This enables patients to be
independent not only in terms of
personal care such as grooming or
using the toilet, but also
performing domestic activities of
daily living such as preparing their
own meals and cleaning up.
The discharge destination
and type of rehabilitation service
recommended is dependent on
the severity of stroke the patient
had and his rehabilitation
potential. It should ideally be
decided after the patient’s
condition has been assessed by and
SUNDAY STAR, 28 OCTOBER 2018
months is possible, but with acute
strokes, permanent disability
cannot be prevented.”
However, stroke survivors
who suffer disabilities can
undergo further treatment
such as physiotherapy and
speech therapy to help them with
rehabilitation.
“Individuals who are at a high
risk of getting a stroke include
people with high cholesterol,
uncontrolled diabetes, high blood
pressure, who binge on alcohol
and are heavy smokers.
“By addressing the risk factors
through medications and a healthy
lifestyle, the risk of getting a stroke
can be diminished significantly,”
says Dr Lee.
Celebrated on Oct 29 annually,
World Stroke Day highlights the
responsibility of every person
around the globe to be aware of
the symptoms of a stroke, the
damages it can cause and the
ways to prevent it. Widespread
awareness is crucial in saving
lives.
n For more information, call
03-7949 9999.
Rehabilitation is
an important part
of recovery after
stroke. The goal
of rehabilitation is
to help the patient
relearn skills lost
due to stroke.
discussed with a rehabilitation
medicine specialist.
Stroke rehabilitation can help a
person recover from the effects of
a stroke, relearn skills and develop
new ways to do things. However,
the patient must be motivated and
realise that the process takes time.
A good relationship with his
rehabilitation team is vital for the
success of the programme.
n For more information, call
03-4021 0464, send a WhatsApp
message to 017-614 3166 (mention
RILU) or visit www.kpjthc.com
KKLIU No.2358/2018
SUNDAY STAR, 28 OCTOBER 2018 Stroke Awareness 7

Prevention is better than cure

ACCORDING to National Health and
Morbidity Survey 2015, non-communicable
diseases such as cardiovascular disease –
including heart attack and stroke –
contribute to an estimated 73% of mortality
in Malaysia.
Hypercholesterolemia is one of the risk
factors for heart disease and stroke. The
formation of plaque in the arteries from high
levels of blood cholesterol restricts
oxygenated blood flow to the brain, causing
a stroke.
The risk of heart disease and stroke can be
minimised by adopting a healthy lifestyle,
which includes:
l Eating a high-fibre diet containing fruits,
vegetables, whole grains or other cereal
products that are high in soluble fibre (such
as oat beta-glucans)
l Eating foods that are low in saturated
fat, trans fat and cholesterol
l Limiting salt (sodium) intake
l Engaging in physical activity for at least
30 minutes on most days of the week
l Drinking in moderation or avoiding
alcohol
l Avoiding smoking
Products made of oat bran such as
Biogrow Oat BG22 Oat Bran Powder contain
a high amount of soluble dietary fibre
known as beta-glucans.
The health benefits of oat beta-glucans,
especially in lowering blood cholesterol,
have been extensively studied.
In addition, oat beta-glucans help
control blood glucose level. Many health
professionals recommend including oat beta-
glucans in the diet of individuals suffering
from or who are at risk of type 2 diabetes.
Made of natural Swedish oat bran, which
consists of soluble and insoluble fibre,
Biogrow Oat BG22 Oat Bran Powder is free
from artificial ingredients, thickeners and
fillers.
Two scoops/sachets (≈18g) of the oat
bran powder daily provide 3g bioactive oat
beta-glucans, which help lower blood
cholesterol and blood glucose levels
effectively. The product has a low glycaemic good viscosity, producing a gelling effect in This article is contributed by Legosan
index value (< 55) and is suitable for the gut for optimal cholesterol-lowering Company (Malaysia) Sdn Bhd.
diabetics. effect.
The powder’s solubility allows it to Start your prevention programme today n For more information, call
dissolve well in cold or lukewarm water. by adopting a healthy lifestyle and 03-7956 2220 or e-mail info@biogrow.com.
It is also scientifically shown to have incorporating oat beta-glucans in your diet. my

Are you at risk?

STROKE is one of the most
prevalent causes of death among
the global population. While
more common in men, fatality
from stroke among women
is higher than that of breast
cancer.
However, the risk of stroke can
be reduced through awareness of
risk factors. Several major ones
are listed below.
l High blood pressure
Also known as hypertension,
this condition occurs when
blood pressure is above the
rate of 140/90. This causes high
pressure to be exerted on blood
vessels, weakening them and
increasing one’s risk of getting
haemorrhagic stroke.
l High cholesterol level
High cholesterol can lead to
the formation of a substance
called atheroma in the blood
vessels. This substance sticks to
artery walls and causes
atherosclerosis, which is a
condition involving the
narrowing and hardening of the
arteries. Stroke can happen
when normal blood flow is
slowed or obstructed.
l Diabetes
High blood sugar level can
contribute to the occurrence
of atherosclerosis. The lack
of insulin in the body to
break down glucose for cell
consumption can lead to excess
fatty deposits and clots in the
bloodstream, increasing the risk
of stroke. Diabetes is usually
accompanied by other risk
factors such as high cholesterol
and obesity.
l Heavy alcohol
consumption
Risk factors of stroke such as
hypertension, diabetes and
obesity are associated with heavy
alcohol consumption. Besides
that, excessive alcohol intake can
trigger atrial fibrillation, which is
a type of irregular heartbeat that
can cause blood clots to form in
the heart. If these clots travel to
the brain, a stroke may occur.
l Smoking
When smoke is inhaled,
various chemicals such as carbon
monoxide, formaldehyde, arsenic
and cyanide can damage healthy
cells in the body, increasing one’s
risk of stroke. Smoking can
increase cholesterol and blood
pressure levels as well as the
likelihood of blood clots forming.
l Obesity
Because of excess fat in the
body, poor blood flow and
blockages (the two major causes
of stroke) can occur. Besides that,
people with obesity are more
likely to have comorbidities such
as high blood pressure, high
cholesterol and diabetes.
These are the main risk
factors, but studies show that
there may be lesser-known
causes of stroke. Stroke can
happen to anyone, even people
who look generally healthy on
the outside. Thus, you should
always be aware of your health
and undergo regular medical
check-ups.
8 Stroke Awareness
TIME is of the essence when
dealing with a stroke. Dr Ramesh
Narenthiranathan, consultant
neurosurgeon at Ara Damansara
Medical Centre, explains, “When
someone suffers a stroke, it means
that brain tissue damage has
already occurred.
“What we need to do is to
control and limit the amount of
damage as much as possible by
starting treatment immediately.”
Strokes are of two kinds –
ischaemic and haemorrhagic. The
latter is more lethal.
“In case of an ischaemic stroke,
which is caused by a clot within a
blood vessel that obstructs oxygen
supply to a part of the brain, there
is a time frame within which the
blood clot needs to be dissolved to
revascularise the brain tissue,” says
Dr Ramesh.
“In haemorrhagic strokes, when
a blood vessel ruptures, damage is
caused not only to the part of the
brain where the primary rupture
occurred. Other parts of the brain
could be damaged as well due to
secondary pressure exerted by the
blood clot mass.
“People often assume that a
blood clot only happens inside a
blood vessel, which can be
dissolved with medication.
However, for haemorrhagic
strokes, blood clots form outside
the blood vessels within the brain
tissue, making brain surgery
necessary in some cases.
“This pressure needs to be
reduced by removing the external
blood clot as soon as possible to
minimise damage to the brain.”
According to Dr Ramesh,
ischaemic strokes are usually
treated by neurologists.
However, if there is a swelling
that exerts pressure on the
surrounding brain tissues, the
assistance of neurosurgeons may
Identify the symptoms and be prompt in taking action
“A STROKE is a sudden onset of
focal neurological deficit due to
infarction or haemorrhage lasting
more than 24 hours. In layman’s
terms, you are suddenly losing
your bodily functions due to blood
clot or bleeding,” explains Dr
Gunasundari Pushparasah,
consultant physician and
neurologist at ParkCity Medical
Centre.
Generally divided into two types,
ischaemic and haemorrhagic,
stroke is a serious condition as
patients can permanently lose
bodily functions or lose their life.
Ischaemic stroke is the more
common type of stroke, accounting
for 80% of all stroke cases. While it
is usually not fatal, patients need to
be aware of the symptoms to
ensure they seek early and
appropriate treatment to prevent
permanent loss of bodily functions.
Dr Gunasundari recommends
the FAST acronym as a helpful way
to remember the danger signs to
look out for and take action before
it is too late.
l Facial weakness
l Arm/Limb weakness
l Speech difficulty
l Time to seek medical
treatment
“Other symptoms include a
sudden loss of vision, unsteadiness
when walking and giddiness.
Individuals who experience these
symptoms should go to the
emergency room immediately.”
Prevention through
knowledge
The main causes of ischaemic
A stitch in time saves lives
Arteriovenous malformation is a cause of stroke.
be needed.
“An ischaemic stroke patient
may need to undergo surgery if his
brain experiences secondary
swelling. Once the swelling exerts
pressure on the surrounding parts
of the brain, immediate surgery is
required to decompress the brain,”
he says.
Dr Ramesh assures that surgery
is not always necessary to treat
haemorrhagic strokes. The need
for surgery depends on the size of
the blood clot and how much of
the brain is affected. A blood mass
of roughly more than 3cm in
diameter usually needs to be
operated on.
He insists that treatment for
strokes involves more than just
removing blood clots. The aim
of stroke treatment is not just
saving lives but to bring back as
Dr Gunasundari Pushparasah.
stroke are atherothromboembolism
(blockage of main blood vessels to
the brain), cardioembolism (clots
that are lodged in the brain due to
irregular heartbeat) and lacunar
stroke (small vessel disease).
According to Dr Gunasundari,
prevention of ischaemic stroke is
divided into two parts – primary
and secondary.
Primary prevention takes place
before a person experiences a
stroke. It focuses on addressing the
risk factors, which include high
blood pressure, diabetes, irregular
heart rate, truncal (apple-shaped)
obesity and lifestyle choices such
as smoking and drinking alcohol.
She adds that the rising
prevalence of stress, depression
and unhealthy lifestyles among the
younger generation may also
contribute to stroke.
Secondary prevention focuses on
stroke survivors. Dr Gunasundari
explains that identifying the cause
A scan showing brain cavernoma.
Going under the knife
The type of brain surgery
performed on a stroke patient
depends on the kind of stroke, its
cause and the amount of damage
done.
According to Dr Ramesh
Narenthiranathan, consultant
neurosurgeon at Ara Damansara
Medical Centre, the types of
surgery are as follows:
l Decompression craniectomy
(removal of the skull bone to
much functionality as possible.
For this reason, he says, “It
is important to undergo
rehabilitation as soon as the
patient is medically stable.”
of a stroke is important in
determining the best methods of
prevention to avoid a recurrence.
“Patients with clots in the main
blood vessels can be treated with
anti-platelet medication,” says Dr
Gunasundari.
“If you have significant
blockages (carotid stenosis) of
more than 70% in the neck, a
carotid endarterectomy procedure
or carotid stenting can be done to
overcome the blockage. A vascular
surgeon will either insert a stent or
surgically remove the blockage.
“Patients with lacunar stroke are
prevent internal compression of
the brain)
l Evacuation of large
hematoma (usually 3cm and
more)
l Microsurgical clipping of
aneurysm (alternatively,
aneurysms can be coiled using
endovascular route similar to
cardiac stents)
l Microsurgical excision of
arteriovenous malformation
Stroke rehabilitation should not
be considered an option, but a
necessary part of the full
treatment process. With timely
treatment and proper
also treated with anti-platelet
medication. Clots caused by
cardioembolism, which is due to
irregular heartbeat, are treated
with anticoagulant medication.”
She stresses that stroke survivors
must adhere to primary preventive
measures on top of their secondary
prevention methods to lower the
risk of recurrence.
Timely treatment
Treatment procedures for
patients depend on the time frame
of stroke detection and treatment.
SUNDAY STAR, 28 OCTOBER 2018
Dr Ramesh Narenthiranathan.
(AVM) (alternatively, AVM
can be embolised using
endovascular route or treated
with radiosurgery)
l Microsurgical excision of
cavernomas
l Brain bypass surgery
for moya moya disease or
syndrome and large giant
aneurysms
l Endoscopic lavage of
ventricular haemorrhages
rehabilitation, stroke patients can
get a second shot at life.
n For more information, call
03-5639 1212.
Dr Gunasundari says, “There are
recent breakthroughs in ischaemic
stroke treatments. Currently,
within the first 4.5 hours of
experiencing a stroke, thrombolytic
therapy medication can be given
intravenously to dissolve the clot in
the brain.
“This is a new emergency
management treatment. However,
eligibility for this treatment
depends on the patient’s medical
history.
“If a patient seeks treatment
within 4.5 to six hours of
experiencing a stroke, a
mechanical thrombectomy
procedure can be done. This is
where an interventional radiologist
inserts a device into the patient to
remove the blood clot from the
brain.
“In the time range of six to 24
hours, certain patients are still
eligible for mechanical
thrombectomy. This is because
medical innovations over the past
decade have increased the critical
window for ischaemic stroke
treatment.”
In the case of a milder stroke or
transient/temporary symptoms,
blood thinner is given to prevent
further clot formation.
“If you experience stroke
symptoms, go to the hospital early
so you can be properly assessed
and given the right treatments,”
she advises.
“The misconception that stroke is
not an emergency should be
debunked, as ignoring the
symptoms could spell significant
ramifications.”
n For more information, call
03-5639 1212.