How to Recognise & Tackle Stroke: Causes, Symptoms, Treatments & Recovery

Stroke is a leading cause of disability and the second leading cause of death globally, making early recognition and intervention crucial. In Singapore, stroke is also a major health concern. It is one of the leading causes of death and long-term disability, as stroke cases number around 8,000 to 9,000 annually, with 2021 seeing 9,680 cases. The rising number of strokes is concerning because this can have a significant impact on families.

This article aims to provide a comprehensive understanding of strokes, from the causes of stroke and symptoms to detailed treatment options and associated costs. We will also stress the importance of quick action at the first sign of a stroke and the crucial role of proper health coverage and financial planning in managing the expenses of treatment and recovery after a stroke.

What causes a stroke?

A stroke occurs when blood flow to a part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. There are two main types of stroke:

Ischaemic stroke

This is the most common type of stroke. It occurs when a blood clot obstructs or narrows an artery leading to the brain. This blockage prevents brain tissue from receiving adequate oxygen and nutrients, leading to the rapid death of brain cells. The primary risk factors for ischaemic stroke include:

• Hypertension (High Blood Pressure): Elevated blood pressure can damage arteries, creating conditions conducive to clot formation.
• Smoking: Smoking contributes to the acceleration of clot formation and atherosclerosis, which is the buildup of fatty deposits in arteries.
• Diabetes: Elevated blood sugar levels can damage blood vessels, increasing the likelihood of clot formation.
• High cholesterol: Excessive cholesterol levels can result in plaque buildup within arteries, leading to their narrowing and an increased risk of blockage.
• Lifestyle choices: Poor dietary habits, lack of physical activity, and excessive alcohol consumption contribute to the development of hypertension, diabetes, and high cholesterol, thereby increasing the risk of ischaemic stroke.

Haemorrhagic stroke

This type of stroke occurs when a blood vessel in the brain ruptures, resulting in bleeding in or around the brain. This bleeding increases pressure on brain cells, causing significant damage. Haemorrhagic strokes are classified into two main types:

• Intracerebral haemorrhage: This type occurs when an artery within the brain bursts, flooding the surrounding brain tissue with blood.
• Subarachnoid haemorrhage: This type involves bleeding in the space between the brain and the thin tissues covering it.

The primary causes of haemorrhagic stroke include:

• High blood pressure: Chronic hypertension can weaken arterial walls, making them more susceptible to rupture.
• Aneurysms: Balloon-like bulges in arteries can stretch and burst, leading to brain bleeding.
• Trauma: Head injuries can cause blood vessels to rupture, resulting in haemorrhagic stroke.
• Arteriovenous Malformations (AVMs): These are tangles of abnormal blood vessels connecting arteries and veins, which can rupture and cause bleeding.

Aside from these, less common causes include arterial dissections or genetic disorders, emphasising the complexity and varied nature of stroke causes. In severe cases, strokes can lead to permanent neurological deficit, a condition classified as one of the 37 critical illnesses recognised by many insurance providers. 

It's important to note that temporary blockages in blood flow to the brain, known as transient ischemic attacks (TIAs), are not considered strokes but can be a warning sign of a future stroke.

Early signs & symptoms of stroke

Strokes can range from very mild with barely noticeable symptoms to severe and life-threatening. The severity depends on the location and extent of brain tissue affected by the blood flow interruption. 

Recognising the early signs of a stroke can drastically improve outcomes. Therefore, remembering this F.A.S.T. acronym can be helpful for recognising stroke symptoms quickly, no matter if it happens to you or someone else:

• Face drooping: One side of the face may droop or feel numb.
• Arm weakness: One arm may feel weak or numb.
• Speech difficulties: Speech may be slurred or hard to understand.
• Time to call emergency services: This is the most important part. If you experience any of these symptoms, even if they go away quickly, call emergency services immediately.

Other stroke symptoms might include sudden confusion, trouble seeing, difficulty walking, or a severe headache. If you notice any of these signs, seek medical help immediately. This acronym also works for people who have encountered transient ischemic attacks. Acting quickly is crucial because strokes can lead to long-term effects such as paralysis, memory problems, and difficulty speaking.

Diagnostic procedures for stroke

Diagnosing a stroke involves several steps to determine the type and severity. The cost of diagnosing a stroke in Singapore can vary depending on the specific tests used, the healthcare facility, and the patient's insurance coverage.

1. Physical exams

Healthcare professionals conduct thorough assessments of symptoms and review the patient's medical history. They might assess the patient’s muscle strength and coordination, balance and gait, sensory abilities (touch, vision, hearing), reflexes, and speech and language skills.

2. CT scans

The healthcare professionals will use X-rays to create detailed cross-sectional images of the brain. CT scans can identify whether the stroke is ischemic or haemorrhagic and exclude stroke mimics such as brain tumours.

3. MRI scans

MRIs use strong magnetic fields and radio waves to produce detailed images of the brain and surrounding tissues, which can visualise soft tissues and pinpoint blockages or damage more precisely than CT scans.

4. Neurological assessments

Comprehensive tests to evaluate the nervous system's function and the impact of the stroke, which is essential for determining the appropriate treatment plan. These tests may include cognitive tests to assess memory, attention, and problem-solving abilities, as well as swallowing evaluation and vision tests.

Despite the potential costs of these assessments, early diagnosis is crucial for receiving the most effective treatment and improving recovery chances. The long-term financial burden of stroke treatment and potential complications can be much higher if diagnosis is delayed.

Treatment options for stroke

If a treatment is needed after confirming the patient’s condition, it varies depending on the type of stroke. The cost of stroke treatment also varies widely based on the type and severity of the stroke, the specific treatments required, and the duration of rehabilitation. For Ischaemic stroke, the treatment includes:

• Clot-busting drugs (Thrombolysis): Medications like tissue plasminogen activator (tPA) can be administered intravenously to dissolve blood clots blocking blood flow to the brain. This treatment is most effective if given within a few hours of stroke onset, with a possible extension to 4.5 hours based on recent studies.
• Mechanical thrombectomy: This is a procedure that involves inserting a catheter into an artery and using a specialised device to remove the clot directly. It is often used alongside clot-busting drugs or when medications are not an option to remove the clot using a catheter.
• Preventive medication: After an ischemic stroke, healthcare professionals may prescribe anticoagulants (blood thinners) or antiplatelet drugs (aspirin) to help prevent future blood clots.

For haemorrhagic stroke, the treatment options include:

• Surgical Options: For haemorrhagic strokes caused by a burst blood vessel, surgery may be necessary to stop the bleeding and reduce pressure in the brain. Procedures such as aneurysm clipping or coiling are common surgical interventions.
• Other Interventions: Medications to manage blood pressure and reduce swelling in the brain are crucial parts of the treatment for haemorrhagic strokes. These measures help stabilise the patient and prevent further complications.

After any stroke, rehabilitation is a critical phase of long-term recovery, including physical therapy, occupational therapy, and speech therapy.

What is the cost of treating stroke

Stroke treatment in Singapore can involve significant costs across various stages of care. Here's a breakdown of the estimated cost of treatment and rehabilitation after a stroke, as well as some major cost factors:

• Emergency care: This includes immediate medical attention and hospitalisation upon experiencing a stroke.
• Surgical procedures: The cost of surgery varies depending on the type and complexity required. Generally, it can be higher than other treatment options.
• Long-term rehabilitation: Rehab after a stroke is an ongoing process that can last for months or even years. The estimated cost reflects a monthly range for therapy and support services.

How to finance stroke treatments

Given the potentially high costs of stroke treatment and rehab after stroke, financial planning for potential health crises is essential. Having health insurance to cover the costs on top of MediShield coverage can be helpful, along with long-term disability insurance that can provide a safety net if long-term effects arise.

To provide more protection for yourself or your loved ones, consider Income’s Complete Critical Protect, a critical illness plan that covers various stages of dread disease and benefits, as long as you are insured before diagnosis and after the respective waiting periods. 

Here’s how it can help you:

• Coverage against recurrent conditions^1,2 like persistent major cancer, recurrent heart attack and recurrent stroke with the Protect Max and Protect Prime options.
• Receive protection for 3 organs vital for survival - heart, lungs and kidneys as a safety measure under Vital Function Benefit^1,3.

No one wants to imagine the possibility of a stroke, but by being prepared, you can significantly reduce the stress and burden associated with treatment and recovery. This includes prioritising early detection through regular health screenings. These screenings can identify risk factors like high blood pressure and cholesterol, allowing for early intervention and lifestyle changes that can significantly decrease the stroke risk for you or your loved ones.

While recognising and tackling stroke is crucial, there's also hope for a fulfilling life beyond it. Early intervention and proper medical care can improve outcomes, and empower you or your loved ones on their road to recovery from stroke.