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Knowing the signs of stroke and calling 995 for an emergency ambulance will help to improve your recovery.
But the best way to avoid disability from stroke is to prevent the stroke from happening!
Quitting smoking and taking care of your health, such as controlling high blood pressure (hypertension), high cholesterol and diabetes will reduce your risk of stroke.
Dr Sumit Kumar Sonu, Associate Consultant from the Department of Neurology at National Neuroscience Institute (NNI), a member of the SingHealth group, will be answering your questions on stroke in this month’s ‘Ask the Specialist’ Q&A forum.
This Q&A forum is open from 1 Oct to 27 Oct 2022.
To post your question, please log in as a member. If you are not a member, you can register for a FREE membership here.
If you have problems posting your questions, please email your questions to marcom@healthxchange.com.sg
Kindly note: Your question will only go live / appear on this page after the doctor answers it
If an individual have Hypertension, High Cholesterol & very Bad Chronic Migraine, is the person predispose or at a higher risk to get a Stroke?
Answered by Dr Sumit Kumar Sonu, Associate Consultant, Department of Neurology, National Neuroscience Institute (NNI)
Hi CYANYI,
We can group all the stroke risk factors into ‘non-modifiable’ and ‘modifiable’.
Non-modifiable risk factors are those that we are unable to control.
For example:
But there are more modifiable risk factors that we can control including high blood pressure, high blood sugar, High LDL cholesterol, atrial fibrillation, smoking, obesity, low physical activity, heavy alcohol intake, psychosocial stress, and depression.
Chronic Migraine and stroke risk
Migraines have not been shown to cause stroke, but a person who has migraine with aura (sensory disturbances such as seeing zig-zag lines and sparkling/shimmering spots, or tingling in the face or hands) is at a very slightly higher risk of stroke in his/her lifetime compared to those without migraine.
However, the overall risk of stroke linked to migraine is still very low, and a person is far more likely to have a stroke because of other risk factors like smoking and high blood pressure.
I am often waken up by headache in the midst of the night (sometimes across my forehead, sometimes at right side if my head) but my headache will be gone in about 30 mins after I take panadol extra and switch off my ceiling fan. Should I be concerned that this is sign of stroke?
HI Theflyingheart,
Headaches can sometimes be a sign of a stroke. Headaches that are brought on by strokes are known as thunderclap headaches that often start suddenly and are intense, with patients describing them as ‘the worst headache in your life’.
Headaches that occur with a stroke typically occur with other classic stroke symptoms, like face drooping on one side, arm weakness and slurred or confused speech.
Strokes are a medical emergency. If you experience any stroke symptoms, including a headache that is sudden and severe, call 995 immediately.
Unfortunately, I am unable to diagnose the cause of your headaches through this platform.
Please consider consulting your family doctor about your headaches.
Sometime, in the mid of my sleep, i would hear wind blowing in both of my ears. Is it the sign of stroke?
Hi Kohbenny082681,
The signs and symptoms of stroke vary from person to person, but usually begin suddenly.
To recognise a stroke, think FAST:
F – Face drooping, uneven smile.
A – Arm weakness on one side of the body.
S – speech difficulty and difficulty understanding speech.
T – if a person has any of these symptoms, call 995 immediately as time is of the essence.
A stroke may also cause sudden onset of:
My father was on Ticlopidine for IHD for more than 20 years. He was not on aspirin due to his drug allergy. Recently he had a stroke and the GM doctor changed his blood thinner to Clopidogrel. Is Clopidogrel a more effective blood thinner in preventing stroke, or a stronger blood thinner should be used?
Dear Mei Chuen,
Ticlopidine, clopidogrel and asprin are effective antiplatelet agents and are useful in the prevention of stroke.
The decision of which antiplatelet medication to prescribe depends on several factors. In your father’s case, asprin is not an option due to his drug allergy and he suffered a stroke despite being on ticlopidine. To reduce your father’s risk of having another stroke, his medication was likely therefore changed to clopidogrel which has proven to be safe and effective in long-term trials.
Question posted by Ajay Mehendra
Hi Dr,
My age is 72 years. Hypertension 40 years. Hypertrophic cardiomyopathy since around 2020. Alcohol septal ablation 2012. Recurrent A F since 2010. Persistent A F since 3 years ago.on Xarelto 20 mg plus bisoprolol. C T coronary angiography lan 2020 showed 50 -70% block proximal L A D and first main branch. Expected to get nuclear myocardial perfusion test and may be followed by angiography and angioplasty.
My questions are:
Hi Ajay Mehendra,
Atrial fibrillation (AF) is a heart rhythm disorder with irregular heartbeat. Patients with AF are at risk of developing blood clots in the heart, which can lead to ischemic stroke.
AF makes you five times more likely to have a stroke. If you’re diagnosed with AF, you’ll have an individual stroke risk assessment to make sure you get the right treatment and advice for you. Anticoagulant drugs, also known as blood thinners, can prevent blood clots from forming and are commonly used in patients with AF – but you need to know your stroke risk first before starting anticoagulation.
With regard to your health and medication (XARELTO - Rivaroxaban) specific question, I suggest you discuss this with your cardiologist. XARELTO may need to be stopped, if possible for one or more days before any surgery or medical/dental procedure if there is high risk of bleeding. Do not stop taking XARELTO without first talking to the doctor who prescribed it to you, as stopping XARELTO increases your risk of having a stroke.
Question posted by Kenneth
Would taking readings from a good quality smart device with features such as, artery check, SpO2 and heart rate monitor, etc., be useful for providing alert to an impending heart attack or stroke?
Hi Kenneth,
The number of wearable devices has exploded in the past five years. But evidence about their accuracy and cost effectiveness is lacking. A major vulnerability of the wearable devices is their susceptibility to motion artefacts, and changes in temperature, hair, skin colour, and tattoos.
Evidence supports the use of wearable devices in cardiovascular risk assessment and cardiovascular disease prevention, diagnosis and management, but large, well-designed trials are needed to establish their advantages.
The smart watch, like other popular smartphone–linked ECG devices, may alert the user about an irregular heartbeat, but not all irregularities are dangerous. If someone with an occasional abnormal rhythm that would never have caused a stroke undergoes an extensive work-up or is put on a blood thinner, the risk of a dangerous bleed or other harm outweighs the benefits of potentially preventing a stroke.
Also, even if someone with a suspected heart attack was able to capture successfully all nine ECG readings, the results would still need to be interpreted by a physician. So for now, the advice for the general public remains the same, "If you have chest pain or symptoms of stroke, call 995 immediately – do not waste precious time fiddling with your smart watch."
Question posted by K Srivastava
I am 78 years old, a little overweight, non-smoker, social drinker occasionally and take medication to prevent High BP, Heart attack and Stroke. I maintain a healthy lifestyle. I love travelling overseas in Asia.
In last 12 years or so, I had 3 mini strokes. The last one was a week at SKH where I was admitted for severe abdominal pain.
Thanks in advance.
Hi K Srivastava,
Transient ischaemic stroke (TIA), often called a mini stroke, may be a warning stroke. It causes symptoms similar to stroke but they last for a short period of time (often a few minutes), and does not cause permanent damage.
About 1 in 3 people who have had a TIA will eventually have a stroke, with about half occurring within a year after the TIA. A TIA can serve as both a warning of a future stroke and an opportunity to prevent it. Prompt evaluation and identification of potentially treatable conditions may help you prevent a stroke.
The risk of recurrent stroke or TIA is high but can be mitigated with appropriate secondary stroke prevention, such as:
Question posted by WeeWang Loy
My MRI 10 years ago shows some low density accumulation up to 50% at first diagonal branch of my Left Anterior Descending vessel. I have been taking medications to control my blood pressure and cholesterol. They are within normal range now, but I wonder what other tests should I do or whether by pass or other procedure should be carried out to prevent risk of complete blockage or stroke? Thank you!
Hi WeeWang Loy,
Your question is more appropriate for a heart specialist to answer as you have likely had cardiac MRI.
For stroke prevention, my suggestion would be to have a healthy lifestyle, take your prescribed medicines and attend your medical appointments or screening regularly.
Question posted by Anne
Since deficiency of protein C can cause CVT and only anti-coagulation drugs can treat it. My question is: Can we treat the deficiency of protein C instead so that when you have enough protein C, CVT will less lightly to occur and you will not need to take anti-coagulation drugs for life.
Hi Anne,
Protein C deficiency is a rare but serious condition in which patients have a higher propensity to develop disseminated intravascular coagulation or venous thromboembolism, which causes blood clots to form in the veins, and these may comprise the initial presentation of the disease.
There are few standardised guidelines for the treatment of protein C deficiency. Newborns presenting with severe protein C deficiency are treated with protein concentrate replacement. Anticoagulation treatments are also an option. Protein C replacement can be costly, so anticoagulation therapies are usually used for managing problems that can arise such as blood clots in veins.
Question posted by Silvam
Dear Dr,
What are chances of someone surviving "haemorrhagic stroke" or "brain haemorrhage". Is Vasculitis the same as the above?
Dear Silvam,
Although haemorrhagic strokes can be deadly, around 4 in 5 people who have had a haemorrhagic stroke survive, according to the National Stroke Registry 2019. How quickly a person receives treatment and how well they follow the treatment also has a lot to do with how much longer they will live. The sooner treatment is received, the longer the person are likely to live. Similarly, adhering to the lifestyle changes and prescribed therapies can increase life expectancy after the stroke.
Vasculitis is a general term for several conditions that cause inflammation in your blood vessels. It can make blood vessels weak, stretched, bigger, or narrower and some types of vasculitis can cause strokes, headaches, seizures
