​In this ‘Ask the Specialist’ Q&A forum, Dr Nijanth M Raj, Associate Consultant from the Department of Neurology at National Neuroscience Institute (NNI), a member of the SingHealth group, answers your questions about stroke.

To submit your question, simply email it to singhealth.healthxchange@singhealth.com.sg

This forum is open from 15 Oct to 15 Nov 2023.

Please allow up to two weeks for your question to be answered. We reserve the right to choose which questions to answer and to close the forum early. 

Do bookmark this page and check back often as we will progressively add answered questions on this page. Only answered questions will be shown.​

Stroke is a leading cause of disability and death in Singapore, yet 4 in 5 strokes can be prevented.

A stroke occurs when a part of the brain gets damaged due to interruption of its blood supply. 

Emergency treatment offers the best chance of a good recovery, therefore knowing how to spot the signs and seek help is vital. To spot the signs of stroke think F.A.S.T:

  • Face drooping - ask the person to smile. Does one side of the mouth droop?

  • Arm weakness - can the person lift both arms above their head. Is one arm unable to stay up? 

  • Speech difficulty - ask the person to say something. Are they unable to speak or are the words slurred?

  • Time to call 995 if you spot one or more of these symptoms.  

The ambulance will alert the receiving hospital so the stroke team can be on standby when the ambulance arrives, helping to prevent delays in treatment.

Symptoms usually occur suddenly but when a stroke happens during sleep, the signs are only noticed when the person wakes up. 

Knowing how to act FAST to spot the signs of stroke and seek emergency treatment can increase your chance of a good recovery.

Better still – learn how to reduce your risk of stroke (here are 10 ways to lower your stroke risk), so you can avoid the physical, mental and social challenges that stroke can cause.

Have a question on how to reduce your risk of stroke, ways to spot the signs or treatments for stroke? Here's your chance to ask our specialist now!

About Dr Nijanth M Raj

Dr Nijanth M Raj is an Associate Consultant with the Department of Neurology at National Neuroscience Institute (NNI). He has a clinical interest in stroke and rehabilitation of patients post stroke. He is also involved in several research trials and quality improvement projects to improve care of stroke patients.

Questions and answers on stroke

1. Question by Serena

Hi doctor,

In June this year, on the day I arrived in UK for a holiday, I suddenly experienced tingling and some numbness on my left arm and left lower leg. This occurred on and off for about one and half weeks.

I did a brain mri. It didn't show any signs of stroke, thankfully. The scan showed a small aneurysm 1mm on my left side.

Does this have anything to do with what I experienced? Does aneurysm lead to stroke? How to prevent it?

Answer by Dr Nijanth M Raj

Thank you for the question.

Intracranial aneurysms have a potential risk of rupture thereby causing bleeding within the brain, termed as hemorrhagic stroke. The risk of rupture increases proportionately with the size of aneurysm, with larger sized aneurysms measuring 7mm and above having a higher risk, and with other risk factors like smoking and hypertension.

The 1mm small aneurysm on the left side of brain is less likely to be the cause of the tingling sensation you had on the left arm and leg.

You should seek medical advice for a full assessment for the cause of the numbness and the follow up for the imaging findings.

2. Question by Peter

Dear Dr,

My wife recently had a mild stroke following a major headache in the early morning. She has partly recovered but continues to have frequent headaches. Why so please and what is the remedy. Thank you.

Answer by Dr Nijanth M Raj

Thank you for the question.

Stroke can be broadly categorized into 2 types:

  • Ischaemic strokes which is due to blockage of blood vessel causing damage to brain tissue due to lack of blood circulation. 

  • Whereas in Haemorrhagic stroke there is bleeding within the brain.

Headaches can happen in a patient with either of the above-mentioned type of strokes. There are many non stroke related headache syndromes as well.

It is difficult to comment on the exact cause of the headache, without knowing about the nature and severity of stroke and without a thorough history and physical examination. We would recommend seeing a neurologist who will be able to take a history, examine the patient and provide optimal treatment for the patient.

3. Question by Joey

Dear Dr Nijanth,

My mother has hypertension and is now taking blood pressure and blood thinner every day.

Couple of months ago, she had a tension headache for few months and led to high blood pressure which shot up to 194. She was in and out of hospital twice because of her high blood.  The CT scan result came out as her headache was just a tension and nothing serious, but because of this, led to her high blood.

Recently, her blood pressure is stable and her headache was gone. But she needs to take her blood thinner every day.

May I know if blood thinner med can really prevent stroke?

Can she stop the blood thinner med someday if she doesn't want to take anymore?

How can she control her blood pressure and by just taking blood pressure tablets, really helps?

Beside this, what does she needs to take care from her high blood?

Answer by Dr Nijanth M Raj

Thank you for the questions.

Blood thinner medications usually refer to antiplatelet agents like Aspirin, Clopidogrel etc or anticoagulant medications like Warfarin, Apixaban etc. The indications, risks and benefits vary between these medications.

I assume the blood thinner medication you mention is an antiplatelet medication, like Aspirin. There is substantial medical evidence that supports the use of antiplatelet medications to reduce the chance of future ischaemic stroke attacks. Due to potential risk of minor to major bleeding it should be taken only on the advice of a doctor. When indicated in the correct setting, antiplatelet medications are advised to be taken life-long for stroke prevention, as long as the benefits outweigh the risks.

Hypertension related headaches are not uncommon in patients especially with poorly controlled blood pressure levels. Besides taking the appropriate medications to control blood pressure, it is important to take a low salt diet, optimize water intake and have a healthy lifestyle that includes measures to reduced stress, provide adequate sleep and exercise.

4. Question by frantaycis

Good morning Dr,

I would like to know whether a mild stroke can be totally reversible. Thanks.

Answer by Dr Nijanth M Raj

Thank you for the question.

A warning stroke or Transient Ischaemic Attack (TIA) does not cause permanent tissue damage to the brain and hence the deficits are totally reversible.

However, when there is an established Ischaemic Stroke (mild or severe) there is some degree of permanent damage to the brain tissue as a result of lack of blood circulation to the affected part of the brain.

The neurological deficits like weakness, numbness, speech difficulty etc, that arise from a mild stroke can potentially be improved to a normal state.

100% recovery though possible, is variable patient to patient, and the chance of recovery is improved with good rehabilitation, especially in the first few weeks to months following the acute stroke.

5. Question by Agnes

Hi Doctor,

May I know what are the ways to accelerate the speech function after a stroke? Mobility was affected but slowly regaining but speech is not improving.

Besides getting a costly speech therapist, which I hardly can afford, what are the other options that can accelerate his speech function as it was very frustrating not being able to communicate.

Thank you for your advice.

Answer by Dr Nijanth M Raj

Thank you for your question.

After a stroke, the cornerstone for recovery is to remain motivated and being persistent with rehabilitation. Please continue to see a speech therapist at regular intervals as much as feasible for your situation. If there are cost concerns, you could check with your doctor who can refer you to a medical social worker to explore possibilities of subsidies.  Ask your therapist for daily speech exercises that you can do at home to optimise your recovery. There are also apps and video resources to help guide recovery as well, which are best advised by a speech therapist.

Aphasia Sg is a not-for-profit organisation that supports people who have difficulty speaking, writing and/or understanding words after a stroke. The organisation runs weekly choir and monthly chit chat sessions for people with aphasia to help them express themselves. More information can be found at: www.aphasia.sg

Singapore National Stroke Association (SNSA) also runs Move With Words group sessions for people with speech difficulty after a stroke. The sessions are held online via Zoom and run by a volunteer speech therapist. For more details and to sign up, visit www.snsa.org.sg

6. Question by Agnes

Hi Dr,

May I enquire if there is any screening that can be done to screen for blood clots that may lead to a stroke (or heart attack)?

Thank you for your advice.

Answer by Dr Nijanth M Raj

Thank you for the question.

There are several risk factors and medical conditions that cause a stroke. The risk factors include high blood pressure, diabetes mellites, raised cholesterol levels and smoking.

There is no specific blood test to screen for stroke. However, you can screen for the risk factors of stroke, which often do not cause any symptoms so can go undetected without screening. Screening would involve having your blood pressure taken and blood tests. If any risk factor is detected, taking appropriate treatment and following the advice of your doctor will significantly reduce the risk of stroke.

7. Question by Sabrina

Hi Dr Nijanth,

Hypertension is one of the factors that can cause stroke to happen. As such, is It advisable for someone suffering from hypertension to use a squatting toilet?

Answer by Dr Nijanth M Raj

Thank you for the question.

There is no significant evidence to suggest increased risk of stroke while using a squatting toilet in someone with hypertension. As such there is no specific recommendation for any particular toilet type. I would recommend to take measures to avoid constipation and straining during passing motion by increasing fibre intake in diet and use of laxatives as recommended by a doctor.

8. Question by JB

Dear Dr. Raj,

Thank you for taking the time to answer these questions. My father died owing to a stroke, and my mom also had an aneurysm, so I am particularly interested in being able to prevent a stroke.

I recently did a "stroke screen" MRI of the brain, and it revealed a 5mm "possible" aneurysm. I did see a neurologist and he said that 5mm was not worrying yet, not to exert myself too much (e.g. carrying a heavy suitcase upstairs), and to repeat the MRI in a year's time to check if the aneurysm has increased in size, and if not, then it should be "stable" and not worry about it.

Just wanted to get your opinion about this, and if you have any further advice to prevent or reduce the risk of an aneurysm in particular.

Answer by Dr Nijanth M Raj

Thank you for the question.

An intracranial aneurysm has a potential risk of rupture causing bleeding within the brain, termed as haemorrhagic stroke. Increase in risk of rupture depends on several factors like the size of the aneurysm, smoking, hypertension, and age of patient. Usually for aneurysms 6mm or smaller, the risk of rupture is about 1% per year. It is wise to have an interval surveillance scan as recommended by the doctor to watch the size of the aneurysm, avoid smoking, optimize blood pressure levels, and follow a healthy lifestyle.

9. Question by HK Tan

Dear Doctor Raj,

I need some help and solution for my medical health issues, hope my questions can be easily answered.

In 2018 I had done cervical spondylosis where my neck C3 to C7 were cut and inserted with titanium to relieve the compression of my nerves.

Until now I still continue to take pregabalin to relieve my nerves pain in both legs and shoulder, and numbness in both hands and legs. Sometimes, a bit headache.

Doctor, can you advise does my above lead to stroke in future and what should I do now to prevent stroke? Any good supplement to recommend or treatment?

Answer by Dr Nijanth M Raj

Thank you for the question.

Cervical spondylosis in itself [PME(1] does not lead to stroke in the future. Please continue to follow up with your spine surgeon to manage your above mentioned symptoms.

With regard to preventing stroke, there is no specific supplement with high quality evidence to prevent or treat a stroke. However, by avoid smoking, having a healthy lifestyle that includes daily exercise and a good diet, regularly screening for risk factors like hypertension, diabetes mellitus and high cholesterol and by keeping these under control with medications and regular follow up, the risk of future stroke can be greatly reduced.

10. Question by Nizam

Greetings Dr,

I was in road traffic accident 2021 and the doctor said I had seizure during the accident after my discharge the doctor said I cannot work so I am now unemployed and a lot of bills to settle. My career is a limousine driver. Can I start driving after 3 years discharge

Your advice is appreciated.

Answer by Dr Nijanth M Raj

Thank you for your question.

I would suggest that you have a discussion with the Neurologist who is taking care of your seizure disorder with regard to your medical condition and for further advice to specific questions such as driving, as he or she will be more equipped with information, such as your history, examination and diagnosis.

Ref: I23