Do You Really Know About Stroke?
Nowadays, no matter where you look, the issue of stroke seems to be getting closer to us. Some may have relatives with this disease, some have to take care of family members who are ill due to this disease, or some may have experienced it themselves, having gone through a life-threatening moment.
Stroke is currently a common problem, both as a cause of death among Thai people and impacting families in terms of care and treatment. In cases of disability, it can be said to be a disease with widespread ongoing effects. Most people commonly refer to stroke as paralysis or hemiplegia because of the symptoms and past treatment outcomes that often failed, resulting in disability.
Stroke is caused by changes in the blood vessel walls, leading to atherosclerosis, plaque formation on the vessel walls, and eventually narrowing of the vessels. Most strokes, over 80%, are ischemic strokes (Cerebral Infarction), and about 20% are hemorrhagic strokes (Cerebral Hemorrhage).
What Are the Symptoms of Stroke?
The symptoms usually occur suddenly. There are 5 warning signs to watch for:
- Sudden weakness of one side of the body or face drooping on one side
- Slurred speech, inability to speak, or difficulty understanding language occurring suddenly
- Sudden loss of vision in one eye, seeing half of the visual field, or double vision
- Sudden dizziness, loss of balance, vertigo, or unsteady walking
- Severe headache unlike any before, accompanied by vomiting or loss of consciousness immediately
The important thing when symptoms occur is that these symptoms may be temporary and resolve on their own, such as weakness lasting about 30 minutes and then improving. This often causes people to be complacent and not see a doctor because they do not realize these are warning signs. Temporary symptoms that improve are called TIA, or Transient Ischemic Attack, a temporary lack of blood flow to the brain. Studies show that 1 in 9 patients with TIA will have a permanent ischemic stroke within 90 days, and 50% will occur within the first 2 days after the warning symptoms. Therefore, it is important to see a doctor for a thorough diagnosis when symptoms occur for timely treatment.
Diagnosis
- The doctor will take a medical history
- Conduct a detailed physical examination, including the nervous system and related systems
- Laboratory tests include:
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- Blood count test: may show thickened blood or high blood concentration, causing poor blood flow, commonly found in heavy smokers or certain blood disorders
- Blood sugar test: helps diagnose diabetes or in diabetic patients using glucose-lowering drugs, low blood sugar can cause symptoms similar to stroke
- Blood lipid test: helps diagnose high blood lipid levels and guide treatment
- Coagulation test (Coagulogram): performed in some cases to detect abnormal blood clotting related to disease
- Electrolyte test: helps differentiate abnormal electrolyte levels, such as low electrolytes, which can cause symptoms similar to stroke
- Other blood tests to assess organ function, such as kidney function or liver enzymes, to assist in medication decisions
- Radiological examinations include:
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- Brain CT scan (64 Slice CT Scan) can be done quickly, providing detailed brain images to clearly distinguish between ischemic or hemorrhagic stroke, and help differentiate brain tumors or abscesses that mimic stroke symptoms
- Magnetic Resonance Imaging (MRI) helps visualize detailed brain tissue abnormalities caused by ischemia more accurately and diagnoses better than CT scans. In some cases, urgent CT scans or small brain abnormalities may not be visible on CT. Magnetic Resonance Angiography (MRA) shows detailed abnormalities of blood vessels from the neck to the brain and is often done alongside MRI. This is a very safe test but has contraindications or precautions for patients with metal implants, such as bone plates or pacemakers, so consult a doctor before the test.
- Carotid Duplex Ultrasound examines narrowing of the carotid arteries or plaque buildup on the carotid artery walls that may affect cerebral blood flow
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How Is Stroke Treated?
Treatment is divided into the following groups:
- Patients with acute ischemic stroke (Acute Ischemic Stroke) currently receive thrombolytic therapy (rtPA: recombinant tissue plasminogen activator) to treat acute ischemic stroke. Studies show better outcomes in patients receiving this drug compared to those who do not. Indications for use are within 4.5 hours from symptom onset to diagnosis due to the risk of bleeding complications. Doctors must evaluate contraindications, perform standard blood tests, and ensure brain CT scans do not show dead brain tissue. The exact time of symptom onset must be known. After careful consideration, the patient’s relatives participate in deciding whether to consent to this treatment. Patients should come to the hospital as soon as possible because diagnosis and blood tests take time. Besides this drug, antiplatelet drugs or anticoagulants are used based on the cause and comorbidities to prevent recurrence and control underlying diseases and risk factors.
- Patients with hemorrhagic stroke will be evaluated by neurosurgeons to determine if surgery is necessary, along with treatment of other comorbidities.
Techniques to Stay Away from Disease and Reduce Risk Factors
Annual health check-ups
- Disease control Control blood pressure: as you age, regular blood pressure checks at least 1-2 times a year are necessary. If blood pressure is high, see a doctor. Control diabetes: try to maintain blood sugar within normal limits. Control blood lipids: if high, consult a doctor. For arrhythmias, see a doctor promptly. If diagnosed with atrial fibrillation (AF), follow the doctor’s recommendations.
- Behavior modification Quit smoking: quitting for 1 year reduces stroke risk by 50%. Avoid alcohol. Maintain a healthy weight. Eat hygienic and nutritious food. Reduce intake of saturated fats and high cholesterol foods such as fatty meats, egg yolks, butter, organ meats, animal oils, coconut milk, coconut water, and palm oil. Prefer low-fat foods such as skim milk, vegetables, fruits, egg whites, fish, lean meats, and vegetable oils. Eat high-fiber foods including vegetables, fruits, brown rice, and whole grains. Avoid overly salty foods or those processed with salt, such as pickled, dried, or canned foods. Finally, exercise daily appropriately for each individual, divided into 3 types: light exercise for about 60 minutes, moderate exercise for 30-60 minutes, and vigorous exercise for 20-30 minutes.
By paying attention to annual health check-ups, controlling chronic diseases, and avoiding risk factors, you can significantly reduce the risk of stroke. For those who have had ischemic stroke symptoms, strict adherence to prescribed medication is essential to reduce the chance of recurrence.
Neurology and Neurosurgery Specialist
Phyathai 3 Hospital
Tel. 02-467-1111 ext. 3262
