Stroke (Cerebrovascular Accident)

A stroke occurs when blood supply to part of the brain is suddenly interrupted or reduced, depriving brain tissue of oxygen. It is a medical emergency in which rapid treatment can significantly reduce long-term disability and death.

• Sudden weakness or numbness of the face, arm, or leg, usually on one side of the body
• Sudden difficulty speaking or understanding speech, or slurred speech
• Sudden vision loss or double vision
• Sudden severe headache with no known cause
• Sudden difficulty walking, dizziness, or loss of balance and coordination

• Most strokes are caused by a blocked blood vessel supplying the brain (ischaemic stroke), often due to a blood clot.
• A smaller proportion are caused by bleeding into or around the brain (haemorrhagic stroke).
• Major risk factors include hypertension, diabetes, atrial fibrillation, smoking, high cholesterol, and older age.

• Diagnosed based on the sudden onset of focal neurological symptoms, assessed using a rapid recognition tool (such as looking for facial droop, arm weakness, and speech difficulty).
• Brain imaging — CT or MRI scan, where available — is used urgently to distinguish between ischaemic and haemorrhagic stroke, as this determines treatment.
• Blood glucose is checked immediately, as low blood sugar can mimic stroke symptoms.

Any suspected stroke requires immediate transfer to a hospital capable of brain imaging, as the type and timing of treatment depend on distinguishing ischaemic from haemorrhagic stroke.

For confirmed ischaemic stroke presenting within the appropriate time window, clot-dissolving (thrombolytic) treatment may be considered at facilities with the necessary capacity, though this depends on strict timing and eligibility criteria.

General supportive care includes maintaining oxygenation, careful blood pressure management, blood glucose control, and early swallowing assessment to prevent aspiration.

Once stable, patients are started on measures to prevent another stroke, such as an antiplatelet medicine (for ischaemic stroke) and control of underlying risk factors like blood pressure and blood glucose.

Early rehabilitation, including physiotherapy, is important to maximise recovery of function.

• Control blood pressure, diabetes, and cholesterol through regular check-ups and treatment adherence.
• Avoid tobacco use and limit alcohol intake.
• Engage in regular physical activity and maintain a healthy weight.
• Seek immediate medical attention for any sudden weakness, speech difficulty, or facial drooping — acting quickly saves brain tissue and improves recovery.