Stroke can affect anyone, and 1 in 4 people will experience a stroke in their lifetime.

On 29 October each year, World Stroke Day reminds us of the serious impact stroke has on individuals and families, calling for greater awareness, stronger prevention, and early recognition and action.

To reduce your risk of stroke – Be S.M.A.R.T

• Smoke-free life: Avoid tobacco.
• Meals: Eat more vegetables, fruits, and whole grains; limit salt and sugar.
• Active lifestyle: 150–300 minutes of moderate exercise per week.
• Regular health screening: Monitor blood pressure, cholesterol, and blood sugar.
• Take prescribed medications: Manage conditions like hypertension, high cholesterol, diabetes, or atrial fibrillation effectively.

To spot a stroke – Think F.A.S.T

• Face drooping
• Arm weakness
• Speech difficulties
• Time to call 995

After a stroke, recovery can take months to years, but no one has to face it alone. Healthcare teams and stroke-focused community partners, including the Singapore National Stroke Association (SNSA) and Stroke Support Station (S3), are here to provide support every step of the way.

In this "Ask the Specialist" Q&A, don't miss the chance to ask Dr Lim Shu Han about stroke. Submit your question now!

Dr Lim Shu Han is a Senior Staff Registrar from the Department of Post-Acute & Continuing Care (PACC) at Outram Community Hospital (OCH). He graduated from Duke-NUS Medical School in 2017 and obtained his Master of Medicine (Internal Medicine) in 2021.

Dr Lim leads the Stroke Rehabilitation team at OCH, where he works closely with a dedicated team of allied health professionals and nurses to support stroke survivors and their caregivers in their recovery journey before their reintegration into the community. He also serves as a Ministry of Health–accredited Severe Disability Assessor, evaluating patients’ eligibility for long-term severe disability financial assistance schemes.

Dr Lim is committed to enhancing post-stroke care for stroke survivors and their caregivers. His work focuses on facilitating early access to intensive rehabilitation, implementing evidence-based strategies to minimize stroke-related complications, and developing seamless care pathways that connect acute hospital, community hospital, and stroke-focused community partners.

1. Question by Joyce

Hi Dr,

My husband had a mild stroke 11 years ago.

The doctor never asked him to go back to review his condition. He is still on blood thinning medication.

I would like to know if this medicine cannot be stopped?

Also, I’m wondering why he doesn’t no need to see the surgeon / doctor anymore?

Thank you for your advice.

Answer by Dr Lim Shu Han

Dear Joyce,

Thank you for reaching out!

After a stroke, blood thinners are often taken for life to help prevent another stroke.

If there are side effects or other medical concerns, a doctor may decide to adjust or pause the medication. It is important not to stop taking blood thinners on his own without consulting a doctor.

If there are no major complications after a stroke that need specialist follow-up at the hospital, it’s common for stroke survivors to continue managing their chronic conditions with primary care doctors at polyclinics or GP clinics.

This also helps to ensure timely follow-up care as waiting time at hospitals can potentially be very long.

2. Question by Lok YT

Dear Doctor,

Just to enquire currently is there preventative medical check-up to prevent any strokes from happening before it is too late?

If there is, please advise where I can seek help for such medical check-up.

Appreciate your advice on my enquiry.

Answer by Dr Lim Shu Han

Dear Lok YT,

Thank you for reaching out!

Your initiative to take charge of your health proactively before any problems arise is truly admirable; it is not always easy to do so

I would like to introduce you to Healthier SG, a national initiative launched by the Ministry of Health (MOH) in 2023 to help Singaporeans proactively manage their health.

By enrolling in Healthier SG, you can receive a subsidised, personalised health plan from your family doctor at polyclinics or GP clinics, along with subsidized screening tests, vaccinations, and medications for chronic conditions.

Do visit Healthier SG to start your journey towards better health!

3. Question by Eric

Hi Dr. Lim,

Does hemifacial spasm increase one’s chance of experiencing a stroke?

Dropping of face on one side when one is sleeping - is that also a sign of stroke? Thank you.

Answer by Dr Lim Shu Han

Dear Eric,

Thank you for reaching out!

Hemifacial spasm, which is an involuntary twitching or contraction of the muscles on one side of the face, is not known to be a common risk factor for stroke.

You are right to be concerned that drooping of face can be indicative of stroke.

However, if this occurs only during sleep, it would be unusual for stroke and may suggest another cause. It is advisable to formally consult a doctor for a thorough evaluation.

4. Question by Bernard

Dear Dr Lim, 

Thank you for this opportunity to engage on my queries about stroke.

I was diagnosed with suspected transient ischemic attack in 2018 and was prescribed statins and aspirin since then.

However, my LDL has remained below the threshold.

Would I be able to adopt lifestyle and dietary practices to mitigate stroke and cholesterol risks in place of statins and aspirin?

What are the side-effects of taking statins and aspirin over time?

Would I be able to cease taking them at some point?

Look forward to your replies, thanks.

Answer by Dr Lim Shu Han

Dear Bernard,

Thank you for your queries and great job!

It is heartening to know that your LDL is below the threshold.

A transient ischemic attack (TIA) can serve as an important warning sign that a person is at increased risk of future stroke.

To reduce this risk, long-term treatment with blood thinners (e.g. Aspirin) and cholesterol-lowering medications (e.g. statins) is often recommended.

Common side effects of Aspirin include bleeding and gastrointestinal irritation, while statins may cause muscle aches and in rare cases, liver dysfunction.

While lifestyle and dietary changes are effective and universally recommended, they may not fully replace medications for every patient, especially those with high-risk profiles for stroke or heart disease.

For now, do continue the combined approach of lifestyle measures and taking prescribed medications before speaking with your doctor. Your doctor will be able to assess you more holistically and recommend a treatment plan that is aligned to your goals.

5. Question by Mr Quek

Dear Dr,

I was told by a cardiologist that I had 20% stroke before my bypass surgery.

What does it mean for me as I already had the bypass surgery? I presume the bypass surgery probably does not prevent the possibility of stroke in future. Is that correct? Thus, I need to rely on my heart medications to prevent stroke?

I can only recall the only possible symptom of stroke being feeling faint and almost passing out once but no other major signs as normally related to stroke, so the above statement by the cardiologist was a surprise.

Thank you for your advice.

Answer by Dr Lim Shu Han

 Dear Mr Quek,

Thank you for your queries!

A heart bypass surgery is usually required when there is severe blockage in one or more arteries in the heart.

Such blockages can also occur in the brain’s blood vessels as the underlying risk factors are similar – namely hypertension, high cholesterol, diabetes, smoking.

You are absolutely right that having a bypass surgery does not eliminate the risk of stroke if these underlying risk factors are not well controlled.

It is important to take your prescribed heart medications and to continue regular follow up with your doctors to keep these risk factors in check.

6. Question by Mdm Wong

Dear Dr,

I have the following history:

Admitted to A & E on 8/3/2018, discharged on 9/3/2018 for chest pain and numbness on the neck.

Diagnosis: Degenerative Disc disease, Atypical Chest Pain and PACs (premature atrial contraction of the heart)

Subsequently, in the same year while I was travelling abroad, my husband noticed my mouth droop, it happened a few times and only in the morning. I went to the hospital there, they gave me aspirin and told me to seek treatment when home.

I did a brain scan which shows a scar. Went to see a stroke specialist but he said I have no stroke.

From then onwards I did not experience any further problems but as I age, I am concerned I am 66 years old and living alone.

I exercise 3 times a week, I don’t have any health problems other than my bone issues.

May I have your advice on this? Thank you.

Answer by Dr Lim Shu Han

Dear Mdm Wong,

Thank you for sharing your story!

Your experience highlights that there are many signs and symptoms that can sometimes be mistaken for an acute stroke (stroke mimics).

In any situation where stroke is suspected, it is important to call 995 immediately for an ambulance so that prompt evaluation can be done at the emergency department. Please avoid self-driving to the hospital.

From what you described, it appears that a Transient Ischaemic Attack (TIA), or “mini stroke”, was suspected in your case.

A TIA happens when a person experiences temporary stroke-like symptoms, which often resolve within minutes to hours and may not be detected on subsequent brain scans. Some individuals may experience more than one TIA.

A TIA is an important warning sign that a person is at increased risk of stroke.

As such, long-term treatment with blood thinners is often recommended to reduce this risk. It is wonderful to hear about your active lifestyle so do keep it up!

7. Question by LST

Hi Dr Lim,

May know the difference between cardioembolic vs non cardioembolic stroke and which is more serious?

Thank you for your reply!

Answer by Dr Lim Shu Han

Dear LST,

Thank you for reaching out!

Both cardioembolic and non-cardioembolic strokes are types of ischaemic stroke, which occur when a blood vessel supplying the brain becomes blocked.

A cardioembolic stroke happens when a blood clot forms in the heart and travels through the bloodstream to the brain, blocking a blood vessel there.

This travelling clot is called an embolus. While the heart is a common source, emboli can also originate from other parts of the body. The most frequent cause of cardioembolic stroke is an irregular heart rhythm known as atrial fibrillation (AF).

A non-cardioembolic stroke, on the other hand, develops from problems within the brain’s own blood vessels.

These vessels may become narrowed or blocked by fatty deposits (plaques). When a plaque ruptures or bleeds, it can trigger the formation of a clot that fully blocks blood flow. High cholesterol, high blood pressure, diabetes, and smoking are key risk factors for this type of stroke.

The severity of a stroke usually depends on the location and size of the affected brain area, rather than the specific cause.

Regardless of the type, both cardioembolic and non-cardioembolic causes require proper medical management to reduce the risk of stroke.

8. Question by T-i L

Dear Dr Lim,

I did a CIMT test overseas and the results showed a 2.2mm plaque build-up in the neck.

Is this result any cause for concern? And how do I reduce/reverse this plaque?

Thank you.

Answer by Dr Lim Shu Han

Dear T-I L,

Thank you for reaching out!

From your description, I believe you are referring to the Carotid Intima-Media Thickness (CIMT) test, which is sometimes used as a form of health screening.

However, I apologize that this is not a test that is commonly used or encountered in my daily clinical practice, so I may not be the best person to interpret your results or advise on the next steps.

I would recommend reaching out to healthcare providers or screening centres that offer this test for more specific guidance.

9. Question by Lim GT

Hi Doctor,

Is it absolutely necessary for patients taking blood thinner such as Aspirin or Clopidogrel to be on gastric medication such as Esomeprazole or Famotidine?

Thank you.

Answer by Dr Lim Shu Han

Dear Lim GT, 

Thank you for your question! 

It may not always be necessary for patients taking blood thinners to also take gastroprotective medications. 

The addition of gastroprotective medications is generally recommended for individuals who have a higher risk of gastrointestinal (GI) bleeding. These risk factors include, but are not limited to:

• Advanced age
• History of GI bleeding or gastric ulcers
• Use of multiple blood thinners
• Concurrent use of steroids and certain painkillers called non-steroidal anti-inflammatory drugs (NSAIDs)
• Helicobacter pylori infection (a type of bacterial infection in the stomach)

The patient’s attending doctor can evaluate their overall clinical profile and determine the appropriateness of initiating gastroprotective medication.

10. Question by Winnie

Dear Dr. Lim Shu Han,

I have a few related questions which many Drs were not able to give me a clear answer:

My sister in mid-70s, for past several years, has been having high Bp upon getting out of bed in the morning, around 155-75-70, but from late morning onwards, her bp has been good around 125-70-72. At night it’s on low side around 110-60-75. 

This has been the pattern for many years. Polyclinic Dr has since given her 5mg Amlodipine to take every night.

We cannot understand why her Bp is still high in the morning. Dr advised it’s ok since the day Bp is good. As the high systolic is always so high, we are afraid it’s affecting the kidneys and other organs … kindly enlighten us.

a) When is the best time to take Bp in the morning, or how long upon rising?

b) Does it mean that Amlodipine is not suitable?

Appreciate your reply and guidance. Thank you.

Answer by Dr Lim Shu Han

Dear Winnie,

Thank you for your queries!

To increase accuracy of morning blood pressure measurement:

• Measure within 30–60 minutes of waking and before food or medications
• Empty the bladder
• Rest quietly for 5–10 minutes
• Sit upright with back supported, arm rested at heart level and both feet flat on the floor
• Avoid talking or moving during measurement
• Use the same arm for every reading

Do give these steps a try and continue recording your sister’s blood pressure readings for her doctor to review.

This will help the doctor determine whether any adjustment to her blood pressure medication is necessary.

Ref: G25