Strokes are the leading cause of death and long-term disability in Singapore. According to the Ministry of Health (MoH), strokes accounted for 5% of all deaths locally in recent years, with thousands of new cases diagnosed annually. Among residents aged 60, and above, the prevalence of stroke is approximately 7.6%, making it a significant public health concern in our ageing population.

A stroke can occur suddenly, but its impact can be devastating, and permanent. Thankfully, strokes are often preventable and can be managed effectively. By understanding the risk factors, recognising early warning signs, and seeking timely medical care, lives can be saved, and quality of life preserved. 

What is a Stroke?

A stroke is a serious medical emergency that occurs when the blood supply to part of the brain is interrupted or reduced. This is usually due to a blocked blood vessel or bleeding within the brain. As such, this disruption prevents brain tissue from receiving essential oxygen and nutrients, causing brain cells to begin dying within minutes.

Because strokes are regarded as medical emergencies, immediate medical attention is crucial to minimise long-term damage, preserve brain function, and improve survival rates.

What should I do right after a Stroke episode?

If you suspect that you or someone else is experiencing a stroke, act immediately. A stroke is a medical emergency that requires urgent attention. This includes:

• Call emergency services immediately – do not attempt to drive yourself or the affected person to the hospital. Instead, dial 995 as paramedics can begin life-saving treatment en route.

• Take note of the symptoms – an accurate timing of when the symptoms began help doctors determine treatment options, particularly for clot-busting medications. This is because these medications must be administered within a specific window.

• Do not give food, drink or medication – swallowing may be impaired following a stroke, thereby increasing the risk of choking. As such, do wait for medical professionals to assess the situation.

• Stay calm – help the person who is affected by stroke to lie down with their head slightly elevated. It is important not to move them unless they are in immediate danger.

• Observe symptoms – do remember to monitor for changes in consciousness, speech, movement or facial drooping. Once paramedics arrive, relay these details to them, as well as to the doctor upon arrival at the hospital. 

What are the types of stroke?

There are three primary types of strokes, which are:

• Haemorrhagic stroke – a haemorrhagic stroke results from a blood vessel in the brain leaking or rupturing, leading to bleeding (haemorrhage) in or around the brain. Some of the common causes include high blood pressure, aneurysms, arteriovenous malformations or head injury.
• Embolic Stroke – an embolic stroke is the most common form, accounting for the majority of stroke cases. It occurs when a blood clot blocks or narrows a blood vessel, reducing blood flow to the brain. The clot may form in the brain's blood vessels (thrombosis) or travel from other parts of the body (embolism). ​

• Transient Ischaemic Attack (TIA) – TIA, or often termed a "mini-stroke," is a temporary period of symptoms similar to those of a stroke. TIAs do not cause permanent damage, and are caused by a temporary decrease in blood supply to part of the brain. However, they serve as warning signs for potential future strokes.

What causes a Stroke?

At its core, a stroke is the result of interrupted blood flow to the brain, depriving brain tissue of oxygen. But this disruption does not occur without warning. In most cases, it stems from underlying damage or dysfunction in the blood vessels, whether they become narrowed by plaque, blocked by a clot or weakened to the point of rupture.

These vascular changes often develop gradually, influenced by a combination of lifestyle factors, medical conditions, and cardiovascular health. Over time, they compromise the brain’s oxygen supply, and increase the likelihood of stroke.

Some of the most common causes include:

• Atherosclerosis (narrowing of arteries) – atherosclerosis is the build-up of plaque inside artery walls, which narrows the vessels, and restricts blood flow. When this occurs in arteries supplying the brain, it significantly raises the risk of clot forming, and causing a stroke.
  
• Atrial Fibrillation, and other heart conditions – irregular heart rhythms such as atrial fibrillation can cause blood to pool in the heart, leading to the formation of clots. These clots can travel to the brain, and block a cerebral artery, triggering a stroke.
  
• Blood Clots – clots may form in the heart or blood vessels, and travel to the brain, obstructing blood flow, and causing an ischaemic stroke.
  
• Diabetes – high blood sugar levels can damage blood vessels over time, and accelerate atherosclerosis, increasing the risk of both ischaemic, and haemorrhagic stroke.
  
• Excessive Alcohol Consumption – chronic heavy drinking can raise blood pressure, lead to heart rhythm abnormalities, and contribute to clot formation. These all contribute to the likelihood of stroke.
  
• High Blood Pressure (Hypertension) – hypertension is one of the most significant risk factors for stroke. It can weaken, and damage blood vessel walls, making them more prone to rupture (haemorrhagic stroke) or narrowing (ischaemic stroke).
  
• High Cholesterol – elevated cholesterol levels contribute to plaque build-up in arteries, reducing blood flow, and increasing the chance of blockages that can cause a stroke.
  
• Obesity – being overweight is linked to several stroke risk factors including hypertension, diabetes, and high cholesterol. Excess weight also increases strain on the cardiovascular system.
  
• Smoking –  tobacco use damages blood vessels, increases blood pressure, and promotes clot formation, making smokers significantly more vulnerable to stroke than non-smokers.

Signs and Symptoms of Stroke

As time is of the essence when it comes to stroke, recognising the signs and symptoms in your loved ones early can save lives. This includes:

• Confusion
• Dizziness or loss of balance
• Severe headache with no known cause
• Sudden numbness or weakness in the face, arm or leg, especially on one side
• Sudden trouble seeing on one or both eyes
• Trouble speaking or understanding speech

What are the warning signs of Stroke?

Additionally, familiarising yourself with the warning signs of stroke can lead to prompt medical intervention, potentially reducing the severity of the stroke’s impact.

Here is how the BE FAST acronym is a helpful guide:

ACRONYM	DEFINITION
B – Balance	Sudden loss of balance or coordination.
E – Eyes	Sudden vision changes in one or both eyes.
F – Face Drooping	One side of the face droops or feels numbs. To confirm, ask the person to smile as an uneven smile is a sign.
A – Arm Weakness	Weakness or numbness in one arm. To confirm, ask the person to raise both arms, and if one drifts downward, it is a concern.
S – Speech Difficulty	Slurred speech or difficulty understanding. To confirm, ask the person to repeat a simple sentence to check coherency.
T – Time to Call Emergency Services	If any of these signs are observed, seek immediate medical assistance.

How does having a Stroke impact your health?

A stroke can have wide-ranging effects on an individual's health, depending on the severity, and the area of the brain affected. These impacts include:

IMPACT	DESCRIPTION
Physical Disabilities	Motor impairments – weakness or paralysis, typically on one side of the body, affecting movement, and coordination.Speech and swallowing difficulties – challenges in articulating words (dysarthria) or swallowing (dysphagia).
Cognitive Impairments	Attention deficits – struggles with concentration, and processing information.Memory loss – difficulty remembering recent events or learning new information.
Emotional and Behavioural Changes	Depression and anxiety – feelings of sadness, hopelessness or excessive worry.Personality shifts – increased irritability, impulsiveness or apathy.
Communication Challenges	Aphasia – difficulty understanding or expressing language, impacting speaking, reading, and writing abilities.
Sensory Disturbances	Numbness or Tingling – altered sensations, often on the side of the body affected by the stroke.
Pain	Central post-stroke pain – chronic pain resulting from damage to the brain’s pain-processing pathways.

Who is at risk of having a Stroke?

Despite the fact stroke is more common senior citizens, it can still affect anyone, especially those with the following risk factors:

• Age – the risk of stroke increases with age. If you are 55 years or older, your chances of experiencing a stroke rise considerably. As the body ages, blood vessels naturally become less flexible, and more prone to narrowing or damage, making stroke more likely.

• Family history – genetics play a powerful role. If your parent, sibling or close relative has had a stroke, your own risk is higher. This may be due to inherited conditions such as high blood pressure, heart disease or a tendency to develop blood clots.

• Gender – while men are generally more likely to suffer a stroke at a younger age, women are at higher risk of dying from stroke, especially after menopause. Hormonal changes, pregnancy complications, and certain contraceptives may also contribute to this increased risk.

• Chronic kidney disease (CKD) – reduced kidney function is closely linked with high blood pressure, and poor vascular health. CKD can lead to hardening of the arteries, and increase the risk of stroke, particularly when accompanied by other risk factors such as diabetes or hypertension.

• Diabetes – high blood sugar levels can harm the inner lining of blood vessels, making them more prone to narrowing, and clot formation. Diabetes also raises the risk of high blood pressure, and high cholesterol, compounding your stroke risk.

• High blood pressure or heart disease – hypertension is one of the most significant risk factors for stroke. It can silently damage your blood vessels over time, increasing the risk of both ischaemic, and haemorrhagic strokes. Similarly, heart conditions such as atrial fibrillation can cause blood clots that may travel to the brain.

• High cholesterol – excess cholesterol in the blood can lead to the build-up of plaque inside your arteries (atherosclerosis). This narrows the vessels, and restricts blood flow to the brain, increasing the likelihood of a stroke.

• Diet – a diet high in sodium, saturated fats, and processed foods can contribute to high blood pressure and cholesterol. 

• Obesity – being significantly overweight places extra strain on your cardiovascular system. Obesity is closely linked to high blood pressure, diabetes, and high cholesterol, all of which raise your stroke risk.

• Smoking – cigarette smoke contains harmful chemicals that damage the lining of your blood vessels, making them more likely to narrow, and form clots. Smoking also raises your blood pressure, and reduces oxygen in your blood, all of which significantly increase the risk of stroke.

How are Strokes diagnosed?

Timely, and accurate diagnosis is essential for determining the type of stroke, and guiding immediate treatment. At Siow Neurology, we adopt a comprehensive, and systematic approach using the following diagnostic categories:

Physical Assessment

• Neurological Examination – our neurologists will start by performing a detailed assessment of reflexes, muscle strength, coordination, balance, and sensory response. Additionally, cognitive functions such as speech, memory, and comprehension are also evaluated to determine the extent of the side effects.

• Vital Signs Monitoring – blood pressure, heart rate, temperature, and oxygen levels are monitored. This is because elevated blood pressure is often a key indicator of stroke or its risk.

• Medical History Review – our doctors will assess personal, and family history, as well as lifestyle factors such as smoking, alcohol use, and existing conditions like hypertension or diabetes.

Imaging Tests

• Computed Tomography (CT) Scan – a CT scan is typically the first-line imaging tool in acute stroke evaluation as it helps to detect bleeding, tumours or other abnormalities.

• Magnetic Resonance Imaging (MRI) – an MRI offers greater detail than a CT scan, especially for identifying small or early ischaemic strokes. Beyond that, MRI helps localise the affected brain tissue,and assess the extent of damage.

• CT Angiography / MR Angiography – these scans evaluate the condition of the cerebral blood vessels, identifying blockages, aneurysms or vascular malformations.

Vascular and Cardiac Tests

• Carotid Ultrasound (Doppler Ultrasound) – a carotid ultrasound is a non-invasive test that uses sound waves to detect narrowing or blockages in the carotid arteries, which supply blood to the brain.

• Echocardiogram – an echocardiogram is an ultrasound of the heart that is used to detect clots, heart valve issues or abnormalities in heart function that may cause embolic strokes.

• Electrocardiogram (ECG) – an ECG assess heart rhythm, and can detect atrial fibrillation or other arrhythmias that increase stroke risk.

• Holter Monitoring – a holter monitor is a portable device worn for 24 to 72 hours to monitor the heart’s rhythm over time, helpful in detecting intermittent arrhythmias.

Laboratory Tests

• Blood Tests – blood tests enable doctors to assess clotting time, blood sugar levels, cholesterol, and markers of infection of inflammation. These tests help determine stroke risk factors and guide ongoing treatment.

How are Strokes treated?

Treatment for stroke is often tailored to the type, severity, and timing of the stroke. Once our neurologists or doctors have determined the type of stroke, they will formulate a treatment plan.

Generally, stroke treatment can be broadly classified into into acute interventions, medical management, surgical procedures, and rehabilitation, as per below:

Acute Stroke Treatment (Emergency Care)

• Blood Pressure Management – immediate control of high or low blood pressure is critical during acute stroke treatment to prevent further brain injury.

• Mechanical Thrombectomy – a mechanical thrombectomy is a minimally invasive procedure to physically remove a blood clot from a large artery in the brain. This is usually performed within 6 to 24 hours of stroke onset, depending on imaging results.

• Thrombolysis (Clot-Busting Medication) – a thrombolysis is only eligible for patients with ischaemic stroke, tissue plasminogen activator (tPA) can be administered within 4.5 hours of symptom onset to dissolve the clot, and restore blood flow.

Medical Management (Post-Acute Care)

• Antiplatelet or Anticoagulant Therapy – medications such as aspirin, clopidogrel or warfarin are prescribed to reduce the risk of future clot formation.

• Management of Underlying Conditions – this includes strict control of diabetes, hypertension, atrial fibrillation, and lifestyle modifications such as smoking cessation, and diet improvement.

• Statins – statins are cholesterol-lowering drugs that help prevent recurrent strokes, especially in patients with atherosclerosis.

Surgical and Interventional Procedures

• Carotid Endarterectomy – a carotid endarterectomy is a surgical procedure to remove plaque from the carotid artery to restore blood flow, and reduce the risk of stroke recurrence.

• Carotid Artery Stenting – a carotid artery stenting is a less invasive option involving the placement of a stent to keep the artery open, and maintain blood flow.

• Surgical Clipping or Coiling – for haemorrhagic stroke caused by aneurysms, neurological intervention may be required to clip or coil the aneurysm, and prevent re-bleeding.

• Decompressive Craniectomy – decompressive craniectomy is often considered in cases of massive brain swelling, part of the skull may be temporarily removed to relieve pressure, and prevent further damage.

Stroke Rehabilitation

• Neuropsychological Support – neuropsychological support involves addressing attention, memory, and mood disorders post-stroke. This includes counselling, and cognitive rehabilitation may be recommended.

• Occupational Therapy – occupational therapy focuses on improving daily living skills such as dressing, eating, and bathing, thereby enhancing independence.

• Physiotherapy – physiotherapy aims to restore balance, movement, and strength. As such, tailored exercises help retain the body, and prevent muscle stiffness or contracture.

• Speech and Language Therapy – speech, and language therapy involves supporting recovering from language disorders, and swallowing difficulties.

 Summary

When it comes to strokes, every second counts. The sooner a stroke is recognised, and treated, the better the chances of limiting brain damage, and improving recovery outcomes. Delayed treatment can lead to irreversible complications, whereas prompt medical attention can save lives and preserve independence.If you or a loved one experiences any signs of stroke, do not wait. Seek emergency care immediately.

At Siow Neurology, we are committed to providing urgent and personalised care for stroke patients, backed by comprehensive diagnostics, tailored treatment plans, and continuous rehabilitation support. Whether you are managing your risk or recovering from a stroke, our team is here to guide you every step of the way.

Schedule a consultation with us today for a detailed assessment and personalised treatment plan. 

Frequently Asked Questions

How long does a stroke last?

The duration of a stroke depends on its type, and severity. A TIA typically lasts a few minutes to several hours, and leaves no lasting damage. In contrast, a full stroke can cause permanent damage if not treated quickly. The longer the brain is deprived of oxygen, the greater the risk of long-term impairment.

What is the difference between a stroke and a heart attack?

A stroke affects the brain, usually caused by a blockage or bleeding that disrupts blood flow to brain tissue. A heart attack involves heart muscles, and occurs when blood flow to the heart is blocked.

Although it impacts different organs, and presents with different symptoms, both are medical emergencies.

Can strokes be prevented?

Yes. Up to 90% of strokes are preventable through lifestyle modifications, and medical management. This includes controlling high blood pressure, managing conditions such as diabetes, and atrial fibrillation, avoiding smoking, exercising regularly, and maintaining a healthy diet.

Are strokes a neurological or cardiac problem?

Strokes are primarily neurological events, as they directly affect the brain. However, many strokes are linked to cardiovascular issues, such as irregular heartbeat, and atherosclerosis, which makes stroke prevention a combined effort between neurology, and cardiology.

What is the stroke survival rate in Singapore?

Survival rates in Singapore have improved significantly due to faster response times, public awareness, and access to specialised stroke care.

How long does it take to recover from a stroke?

Recovery varies based on the type, location, and severity of the stroke. Some individuals regain function within weeks, while others may require months of rehabilitation or ongoing support. Be that as it may, early intervention, and physiotherapy can greatly enhance the recovery process.

Are there any permanent side effects from a stroke?

Depending on the area of the brain affected, a stroke may result in long-term effects such as weakness or paralysis, speech and language difficulties, memory loss or cognitive decline. However, with comprehensive rehabilitation, and support, many patients achieve meaningful recovery and improved quality of life.