STROKE IN MALAYSIABY; AHMAD FIRDAUS BIN AHMAD TERMIZI MOHD.ZHAIEM BIN MOHAMMAD

Introduction

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.

Tuesday April 24, 2007Killer stroke: Six Malaysians hit every hourBy M. KRISHNAMOORTHYkrishna@thestar.com.myPETALING JAYA: Six new cases of stroke occur every hour in Malaysia, Health Minister Datuk Seri Dr Chua Soi Lek

said.He said it was surprising that about 52,000 Malaysians suffered strokes annually when it is the most preventable

of all life-threatening health problems.“In 2005, 17,909 stroke victims were admitted into government hospitals alone throughout the country. Of

these, 3,245 of them were fatal. By 2020, this figure is expected to exceed 25,000 every year.“Many of the risk factors for stroke can be controlled if people change their lifestyle and also exercise regularly,” he said

after launching a book entitled Understanding Stroke by the National Stroke Association of Malaysia (Nasam).Dr Chua said the main reason for the increasing number of stroke cases was that many Malaysians leading an

unhealthy lifestyle, including being obese, smoking and failure to control hypertension, high cholesterol level and diabetes.

“Hypertension, which is a major risk factor for stroke, is scarily becoming prevalent among Malaysians.“According to the National Health and Morbidity Survey in 1986, hypertension was prevalent among 14.4% of

adult Malaysians aged 30 years and above. “In 1996, the figure had jumped to 29.9%, which is equivalent to a 100% increase,” he said.Dr Chua said one of the ministry’s strategies for health-related diseases such as stroke was to organise health-promotion activities.

“Some RM37mil has been allocated to the newly set-up Health Promotion Board to provide funding to health-related NGOs and professional health associations to act as catalysts to promote the culture of healthy living among Malaysians.

“I believe strongly that we should focus more on the prevention than the treatment of diseases.” he said.Dr Chua commended Nasam for the publication of Understanding Stroke and educating the public on how to reduce the risks

of stroke.The book will be distributed widely to educate the public on stroke prevention and what to do in the event of a stroke.Nasam chairman Janet Yeo said most of the time people thought they would not suffer a stroke.“And, when it does happen, it is too late to regret not having done the right things to avoid it,” she said.

Tuesday October 25, 2005, The StarStroke now the number three killer in MalaysiaSTROKE has become Malaysia's number three killer after heart disease and cancer, with an average

of 110 people dying of it every day, reported China Press.Prof Dr Tan Chong Tin, senior consultant at the Neurology Clinic of the Universiti Malaya Medical Centre, said

that according to the centre’s statistics on stroke in 1994, 59% of the patients were male and the patients' average age was 62.

He said the majority of the patients were Chinese, followed by 29% of Malays and 21% of Indians.Dr Tan said 70% of stroke patients who recovered stopped taking part in social activities, 30%

needed assistance in coping with daily life and 15% died within a month.People from developing nations were at greater risk of suffering from stroke than those from

developed nations like Japan who have better lifestyles and knowledge of health risks, he said, adding that the number of stroke patients was rising in developing nations.

Dr Tan said stroke could be prevented by adopting a healthy lifestyle and diet and being aware that the major causes of stroke were high blood pressure and diabetes.

He also said that it was medically proven that 70% of stroke cases were preventable.Meanwhile, Nanyang Siang Pau reported that Hong Kong star Nadia Chan Chung Ling, who will be playing a lead

role in the celebrated musical Snow Wolf Lake showing here next month, visited burn victim Wong Jing Ren.The two-year-old boy was badly burnt in an accident at a relative's house on Sept 27.Chan urged the public to donate generously to help Jing Ren.

What is a stroke?A stroke is a brain attack and occurs when the blood supply to the brain is disrupted. The brain is the nerve center of the body, controlling every thing we do or think, as well as controlling automatic functions like breathing. 

In order to work, the brain needs a constant blood supply which carries vital oxygen and nutrients. When a blood vessel in your brain bursts or gets clogged, the blood supply stops and the brain cells are deprived of oxygen and nutrients. That part of the brain starts to die. You have a stroke. Very quickly. Very silently. 

Brain damage affects your senses, your speech and understanding of language. One side of your body may be paralyzed, your behavior, thought and memory patterns are altered. 

What causes stroke? There are two main types of stroke, and each has

different causes. The first type, an ischaemic stroke, occurs when a blood clot blocks an artery serving the brain, disrupting blood supply. Very often an ischaemic stroke is the end result of a build up of cholesterol and other debris in the arteries (atherosclerosis) over many years. 

The second main type of stroke is a haemorrhagic stroke, when a blood vessel in or around the brain bursts, causing a bleed or hemorrhage. Long-standing, untreated high blood pressure places a strain on the artery walls, increasing their risk of bursting and bleeding. 

Ischaemic stroke

An ischaemic stroke may be due to:

1. A cerebral thrombosis, in which a blood clot (thrombus) forms in a main artery leading to the brain, cutting off body supply.2. A cerebral embolism, in which a blood clot forms in a blood vessel elsewhere in the body, for instance in the neck or the heart, and is carried in the bloodstream to the brain.3. A lacunar stroke, in which in the blockage is in the small blood vessels deep within the brain.

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

Hemorrhagic stroke

1. An intracerebral haemorrhage, in which a blood vessel bursts within the brain itself.2. A subarachnoid haemorrhage,in which a blood vessel on the surface of the brain bleed into the area between the brain and the skull, known as the subarachnoid space.

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

Who is at risk?A number of different factors increase the risk of stroke, including: 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.

Risk factors that cannot be controlled Age. Strokes are more common in people over

55, and the incidence continues to rise with age. This may be because atherosclerosis takes a long time to develop and arteries become less elastic with age, increasing the risk of high blood pressure.

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.

What are the symptoms? Stroke does not just happen. Often, there are warning

signs. By recognizing these signs and taking prompt action to get medical attention, you can avoid an impending stroke or reduce it severity.

 The key symptoms are:

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  

Effects The effects of a stroke vary from person to person, depending on

which part of the brain is damaged and the extent of that damage. For some, the effects are relatively minor and short-lived; others are left with more severe, long term disabilities. Common problems include: 

Physical deficits after stroke 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.

Cognitive deficits Becoming cautious, anxious and

disorganized. Easily depressed, inability to control

emotion. Poor concentration in learning new

skills. Inability to understand speech.

Spatial-perceptual deficits Inability to judge distance, size,

position. Loss of feeling in one side of the

body. Loss of body image.

Treatment 1. Blood pressure drugs-High blood pressure is the most common

cause of stroke. There are several types of drugs to treat this condition. Some of the most common types of drugs are: 

i. Diuretics – rid the body of excess fluids and salt (sodium) ii. Beta-blockers – reduce the heart rate and the heart's output of

blood 2. Anti-platelet drugs and aspirin to prevent blood clots 3. Drug for atrial fibrillation (irregular heartbeat) 4. Cholesterol-lowering drugs 5. Drugs for Diabetes Mellitus 6. Regular Medical Check-Up

Avoiding Stroke Become more physically active. Exercising helps to lower blood pressure

(high blood pressure is the single biggest risk factor for stroke), controls weight, helps create a healthy balance of blood fats and improves your body's ability to handle insulin. Aim to do some kind of moderate physical activity for 30 minutes for at least five days of the week.

Eat a healthy diet. Fresh fruit and vegetables are rich sources of antioxidant vitamins and minerals, which research has found, reduces the risk of stroke. A high consumption of salt has been linked to high blood pressure, while too much saturated fat can lead to atherosclerosis (furring of the arteries).

Stay a healthy weight. Being overweight is a risk of a stroke. Don't smoke. Smoking increases your risk of stroke because it causes

atherosclerosis (furring of the arteries) and makes the blood more likely to clot.

Drink sensibly. Watching your alcohol intake can help you avoid stroke. Avoid heavy drinking, especially drinking large amounts of alcohol in one go, as this can cause blood pressure to soar. Don't drink every day. Try to have at least a couple of alcohol-free days a week.

Get your blood pressure checked. All adults should have their blood pressure checked at least once every five years (more often is they have high blood pressure), are taking medication or have other underlying conditions.

Seek advice from your doctor before taking contraceptive pill or going for HRT.