Stroke in Malaysia

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Stroke in Malaysia

• BY AHMAD FIRDAUS BIN AHMAD TERMIZI
• MOHD.ZHAIEM BIN MOHAMMAD

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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.

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• Tuesday April 24, 2007
• Killer stroke Six Malaysians hit every hour
• By M. KRISHNAMOORTHY
• krishna_at_thestar.com.my
• PETALING 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 ministrys
  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.

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• Tuesday October 25, 2005, The Star
• Stroke now the number three killer in Malaysia
• STROKE 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 centres
  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.

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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. 
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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. 

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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 clotA blood clots get stuck in an artery
and blocks the blood flow.
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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 strokeWhen an artery bursts blood
is forced into the brain tissue, damaging cells
so that area of the brain can't function.
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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.

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• 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.

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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  

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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.

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• Cognitive deficits
• Becoming cautious, anxious and disorganized.
• Easily depressed, inability to control emotion.
• Poor concentration in learning new skills.
• Inability to understand speech.

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• Spatial-perceptual deficits
• Inability to judge distance, size, position.
• Loss of feeling in one side of the body.
• Loss of body image.

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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

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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.

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• 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.

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