Stroke 101: Signs, Symptoms, Causes, Types and Prevention

Medically Reviewed by M Thiviya, R.N.

With prompt treatment, stroke does not have to be disabling or deadly. Possessing knowledge of how to spot the signs of stroke and what actions to take can possibly help save a life and avoid potential complications when it strikes. There are also many lifestyle changes we can make to reduce our risk of stroke.

Read on to learn more about the different types of stroke, its early signs, symptoms and causes, as well as how we can prevent it.

What is stroke?

Stroke occurs when blood supply to parts of our brain is reduced or interrupted. This deprives our brain tissue of the nutrients and oxygen necessary for its survival. Within minutes, the cells start to die, impeding our brain functions.

Types of stroke

In Singapore, two forms of stroke account for 99.9% of its occurrence — ischaemic and haemorrhagic. Some people may also experience a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA).

Ischemic Stroke

Ischaemic stroke is the most common type of stroke, accounting for 79.9% of all stroke cases in Singapore. It occurs when there is a blood vessel blockage, limiting blood flow to the brain. 

Blood vessel blockages are often caused by embolism or thrombosis. An embolism occurs when a blood clot travels along our bloodstream and lodges in the blood vessels in our brain, while thrombosis occurs when fatty deposits cause the blood vessels in our brain to narrow, resulting in a blockage.

Hemorrhagic Stroke

Hemorrhagic stroke accounts for 20% of all stroke cases in Singapore and occurs when a blood vessel in our brain leaks or ruptures, causing bleeding in the brain. 

A ruptured blood vessel is often the result of poorly-managed high blood pressure, trauma, overuse of blood thinners (anticoagulants), bulges at weak spots along the blood vessel walls (aneurysm), protein deposits along blood vessel walls that leads to weak spots (cerebral amyloid angiopathy) and ischemic stroke that lead to haemorrhage.

Transient Ischemic Attack (TIA)

Those with Transient Ischemic Attack (TIA), also called a ministroke, experience the symptoms of a full-blown stroke, but only temporarily. The symptoms may even last as short as just 5 minutes. 

Similar to ischemic stroke, TIA is caused by a reduction of blood flow to the brain due to blood vessel blockage. While TIA usually does not have a long-term impact, it is an indicator that we may have a partially blocked or narrowed artery that may increase our risk of stroke later in life. If you experience symptoms of stroke, you should seek emergency care even if the symptoms subsided, as it’s not possible to tell apart TIA and other forms of stroke solely based on your symptoms.

Signs of Stroke

The type of stroke and the part of the brain affected can manifest different symptoms. An easy way to remember the common symptoms of stroke is through the acronym “BE FAST”, which also double up as a reminder that speed is key when stroke strikes.

• Balance: A person with a stroke may feel dizzy, stumble or experience a loss of coordination.
• Eyes: Those having a stroke may have blurred or blackened vision, face trouble seeing in one or both eyes, or see double.
• Face: Stroke may cause facial numbness, often only on one side, resulting in the tell-tale sign of facial drooping.
• Arm: If a person is unable to raise one arm or if it drifts downwards, it may indicate a weakness or numbness in one arm, a sign of stroke.
• Speech: A person with a stroke may appear confused, have difficulty speaking and understanding speech, and tend to slur.
• Time: In stroke treatment, time is crucial. Brain cells die with every passing minute. Call 995 immediately if you observe any of the above symptoms.

Other symptoms of a stroke can include a sudden and severe headache, vomiting and fatigue. Learn more about the early warning signs of stroke and how to help someone having a stroke here.

5 things to do when someone is having a stroke

Call 995 immediately

In stroke treatment, time is crucial. Brain cells die with every passing minute. If you notice a person displaying any signs of stroke, call 995 immediately instead of transporting the affected individual to the Accident and Emergency department on your own. 

Dialling 995 not only ensures the prompt transportation of the person with stroke to the hospital. This call also triggers a chain of events. Trained paramedics will be able to identify the symptoms of stroke, administer life-saving treatment en-route to the hospital, and inform the emergency department so that appropriate immediate medical attention is available upon arrival. 

Take note of when the symptoms started

Some of the most effective treatments for stroke can potentially reverse or stop symptoms from progressing. However, it has to be administered within 6 hours from the start of symptoms.

With an awareness of the time the symptoms started, the most appropriate and effective treatment can be determined.

Perform CPR if necessary

It has been observed that we may fall unconscious during a stroke. If consciousness is lost, check their pulse and breathing. If there is no pulse, start performing CPR immediately.

Do not give them food or drink 

Avoid giving food or drink when you suspect someone is having a stroke. A stroke can cause general muscle weakness or even paralysis. This may result in swallowing difficulty, posing a risk of choking.

Do not give them any medication

Depending on the type of stroke, different types of treatment will be required. While a blood-thinning aspirin may help with ischaemic stroke, it may be detrimental for someone with a haemorrhagic stroke. 

With no visible way of distinguishing the type of stroke a person is having, it is best not to administer medication as it could further complicate matters or worsen the condition.

What causes stroke?

There are many risk factors that can increase our stroke risk. Some are non-modifiable factors such as age and family history, while others are lifestyle factors that we have control over.

Age

Our arteries naturally become narrower and harder over the years, which is why our stroke risk tends to increase with age.

Family History

Some strokes may be caused by genetic disorders that may block blood flow to the brain. If a close relative of yours has had a stroke, your stroke risk may be higher as well.

Weight

Being overweight makes it more likely for us to develop high blood pressure, heart disease, high cholesterol and type 2 diabetes, all of which contributes to higher stroke risk.

Excessive Alcohol Intake

Excessive alcohol intake can raise our blood pressure and cholesterol levels, and may even trigger an irregular heartbeat. These can contribute to an increased risk of stroke. 

Tobacco Use

Cigarette smoke, including second-hand smoke, can cause a fatty buildup in our main neck artery and thicken our blood, making it more likely to form a clot. Nicotine also increases our blood pressure and hence our risk of stroke.

Existing Health Conditions

Pre-existing medical conditions can significantly increase our risk of stroke. 

• Hypertension: The leading cause of stroke in Singapore, more than one in four who had a stroke had high blood pressure. When poorly managed, hypertension puts extra strain on our heart and blood vessels, leading to an increased risk of the formation of blood clot and narrowing of blood vessels.
• High cholesterol: Too much cholesterol in our blood can lead to fatty buildup on artery walls, increasing our risk of ischaemic stroke.
• Stroke or transient ischemic attack (TIA): Those who previously had stroke, TIA or heart attack have a higher risk of a stroke recurrence. 
• Diabetes: Excess sugar in our blood can lead to buildup of clots or fat deposits along our blood vessels, leading to an increased risk of stroke.
• Heart conditions: Some heart conditions such as coronary artery disease may cause plaque buildup in our arteries, while heart valve defects, irregular heartbeat and enlarged heart chambers may cause blood clot that could break loose and block the flow of blood to our brains.

How to prevent a stroke?

While some risk factors of stroke such as age and family history are non-modifiable, there are many lifestyle habits we can adopt to significantly reduce our stroke risk.

Lower your blood pressure

High blood pressure is one of the top causes of stroke. If you have hypertension, make sure you follow these 7 steps to keep your blood pressure under control and reduce your stroke risk.

However, we may not always know that we have hypertension since it often does not show any symptoms. Hence, for those with normal blood pressure levels, it is recommended that we take a blood pressure reading at least once every 3 years.

Avoid smoking

It is commonly known that smoking is harmful to our bodies, including raising our risk of stroke. If you don’t smoke, don’t start. If you do smoke, get support and quit smoking today to reduce your stroke risk.

Take note of your heart health

If you have pre-existing heart conditions, make sure you consult your doctor and follow their advice to keep it under control, to reduce your risk of stroke.

Stay active

Exercising can help us lose weight and reduce the likelihood of us developing health conditions such as diabetes, hypertension and high cholesterol, which are risk factors of stroke.

You can start small by choosing to take stairs instead of the escalator and taking the longer route home. Doing a short 30-minutes workout at home, 5 days a week, can also help. 

Limit your alcohol intake

Drink in moderation, or not at all. To prevent any health complications caused by excessive alcohol intake, ladies should limit themselves to 1 drink a day, while men should only have up to 2 drinks a day.

Adopt a healthy diet

Load up on fresh fruits and vegetables and cut down your intake of salt and trans and saturated fats, which can clog our arteries and raise blood pressure. Eating healthy can also help us shed some weight, further reducing our stroke risk.

Manage your diabetes

If you have diabetes, keep it under control with regular exercise, a healthy diet and medication prescribed by your doctor. 

Watch your cholesterol levels

Exercising regularly and sticking to a healthy diet can help to reduce your cholesterol levels, but sometimes it may not be enough. Sometimes, doctors may prescribe medication to help keep your cholesterol in check.

Take your medication

For those with an existing health condition that raises your risk of stroke, make sure you follow your doctor’s advice and keep it under control. If you have had a stroke previously, make sure to take any medication your doctor prescribes to prevent another one.

Caring for a loved one post-stroke

Stroke recovery is a gradual process that can take several months to years. Starting rehabilitation therapy, including physio- and speech therapy, as soon as possible can be greatly beneficial in recovery. Learn about what to expect throughout the entire stroke recovery and rehabilitation process here. 

Your doctor may also prescribe medications such as blood thinners post-stroke to reduce the chances of another stroke occurrence. These are usually long-term medications that need to be taken for life.

Besides professional medical care and rehabilitation therapy, familial support can go a long way in helping your loved ones regain independence and rediscover self-confidence. Find out how you can make a difference to your loved one’s recovery post-stroke here. 

Should you need support caring for a loved one recovering from a stroke, we can help.