Stroke of the ischemic kind is one of the leading causes of death and disability in Thailand. It arises from insufficient blood reaching the brain, so that the brain cells lack oxygen and die quickly. Knowing the symptoms and the correct treatment is therefore important and may save life and greatly reduce disability. This condition needs urgent care and suitable rehabilitation in the long term.
The warning signs of 'ischemic stroke' that must be known immediately
Knowing the warning signs of ischemic stroke helps us give help to the patient in good time and increases the chance of a better recovery. The symptoms of ischemic stroke usually arise suddenly and need urgent care.
The important symptoms to notice, according to the F.A.S.T. principle, are:
- F (Face) – the face is twisted, they cannot smile, or the mouth is twisted to one side
- A (Arms) – the arm is weak, they cannot raise the arm, or can raise it but it falls
- S (Speech) – speech is unclear, they cannot speak, or they understand speech abnormally
- T (Time) – note the time and hasten to take them to hospital immediately
Besides the main symptoms, there may also be other symptoms, such as:
- A severe headache arising suddenly
- Unsteady walking, or loss of balance
- Blurred vision or sudden loss of vision
- Numbness or weakness on one side of the body
What are symptoms that come and go (TIA)? A warning sign that must never be ignored
TIA, or Transient Ischemic Attack, is a state in which the blood reaching the brain decreases temporarily, causing symptoms similar to ischemic stroke, but the symptoms go away by themselves within 24 hours, mostly within 1 hour. Although the symptoms have gone away, TIA is considered a very important warning sign, because patients with TIA have a risk of a real ischemic stroke as much as 10 times higher within 90 days after the TIA. So if these symptoms arise, a doctor must be seen without delay for examination and a plan of prevention.
What is ischemic stroke (Ischemic Stroke), and how does it differ from haemorrhagic stroke?
Ischemic stroke arises from the blockage or narrowing of an artery feeding the brain, so that not enough blood flows to feed the brain tissue, with the result that the brain cells lack oxygen and nutrients until they are damaged or finally die. This condition accounts for about 80-85% of all patients with stroke.
The important differences between ischemic stroke and haemorrhagic stroke:
Ischemic stroke:
- Arises from the blockage of an artery
- The symptoms usually come on gradually, or arise on waking
- Treatment emphasises opening the way for the blood and dissolving the clot
Haemorrhagic stroke:
- Arises from the rupture of an artery
- The symptoms arise suddenly and severely
- There is usually a very severe headache
- Treatment emphasises stopping the bleeding and reducing the pressure in the brain
Who is at risk of ischemic stroke? The causes and risk factors that can be prevented
Knowing the risk factors helps us prevent the condition effectively. The risk factors divide into 2 kinds: factors that cannot be controlled and factors that can be controlled.
Risk factors that cannot be controlled:
- Increasing age (particularly over 55 years)
- Male sex (a higher risk than female)
- A family history of stroke
- Race (black people are at higher risk)
Risk factors that can be controlled:
- High blood pressure (the most important cause)
- Diabetes
- High blood fat
- Heart disease, particularly an abnormal heart rhythm
- Smoking and drinking alcohol regularly
- Obesity and a lack of exercise
- The use of contraceptive pills in women with other risk factors
Treating ischemic stroke: every second is the 'Golden Hour'
Treating ischemic stroke has to be done urgently, because with every minute that passes the brain cells continue to die. The idea "Time is Brain" is therefore the important principle in treatment, with several periods of golden time important to the result of the treatment.
Giving a clot-dissolving medicine (tPA) within 4.5 hours
The clot-dissolving medicine, or tPA (tissue Plasminogen Activator), is the main treatment for patients with ischemic stroke in the acute stage. This medicine works by dissolving the clot blocking the blood vessel in the brain, so that the blood can flow to feed the brain tissue again. The effectiveness of this medicine is highest when it is given within the first 3 hours, and it must be given within 4.5 hours after the symptoms arise. The sooner it is given, the better the chance of recovery.
Drawing out the clot through a catheter (Mechanical Thrombectomy)
For patients with a large clot blocking a main large blood vessel in the brain, using a special instrument inserted to pull the clot out directly gives a better result. This method is called Mechanical Thrombectomy: the doctor passes a catheter through the large blood vessel in the leg up to the brain, and then uses a special device to grip or suck the clot out. This method is highly effective and can be done within 6-24 hours, depending on the state of the patient.
What happens on arriving at the hospital?
When the patient arrives at the hospital, the medical team acts urgently to diagnose and treat. The first step is assessing the symptoms and a preliminary physical examination, followed by a CT Scan of the brain to distinguish between ischemic and haemorrhagic stroke, and a blood test to see the clotting of the blood and the working of the kidneys. In some cases a CT Angiography or MRI may be needed to see the blood vessels of the brain in detail. After the diagnosis, the doctor will decide on the method of treatment most suitable for each individual patient.
How to prevent ischemic stroke, and restoring the body after treatment
Preventing ischemic stroke is important and everyone should give it importance, particularly controlling the risk factors that can be changed. Holistic treatment and suitable rehabilitation help the patient return to living with quality.
The important ways of preventing it are:
- Control the blood pressure within the normal range (less than 140/90 mmHg)
- Control the level of sugar in the blood if you have diabetes
- Exercise consistently, at least 150 minutes a week
- Eat food of benefit, reducing salt, sugar, and saturated fat
- Stop smoking and reduce drinking alcohol
- Control the weight within the normal range
For patients who have been through treatment, rehabilitation is very important. Physiotherapy helps restore movement and the strength of the muscle. Modern technology such as therapy with a magnetic field (PMS) can help stimulate the working of the nerves and hasten recovery effectively.
Frequently asked questions (FAQ) about ischemic stroke
Can ischemic stroke be cured completely?
The chance of recovery depends on several factors, such as the severity of the blockage, the area of the brain affected, the speed of receiving treatment, and the age of the patient. Some patients can recover completely, if they receive rapid and suitable treatment, while others may have some disability remaining. Continuous rehabilitation and suitable care help increase the chance of recovery as much as possible.
Can young people develop this condition?
Although ischemic stroke is often found in older adults, young people can develop it as well, particularly those with high risk factors, such as congenital heart disease, the use of narcotics, the use of contraceptive pills together with smoking, an abnormality of blood clotting, or inflammation of the blood vessels. Statistics show that about 10-15% of patients with ischemic stroke are aged under 45 years. Caring for your health and having regular health checks is therefore important at every age.
Summary
Ischemic stroke is an emergency state needing urgent treatment. Knowing the early symptoms according to F.A.S.T. and responding quickly can save life and greatly reduce disability. Preventing it by controlling the risk factors that can be changed, such as high blood pressure and diabetes, and by changing lifestyle, is the key to reducing the risk of this condition.
For patients needing rehabilitation after an ischemic stroke, receiving treatment from a specialist physician in rehabilitation medicine, together with modern technology, helps hasten recovery and improve quality of life effectively. At PYONG Rehabilitation Clinic there is a team of specialist physicians and modern technology ready to care for and rehabilitate patients with quality, in order to help the patient return to living happily and with a better quality of life.
📞 Enquiries and appointments: (+66) 88 589 0896