Stroke: Comprehensive Guide to Emergency Treatment & Recovery

A stroke is a medical emergency that occurs when blood flow to part of the brain is interrupted or reduced. This prevents brain tissue from receiving sufficient oxygen and nutrients. Timely treatment is important, as prolonged disruption of blood flow may lead to irreversible brain cell damage. Understanding stroke symptoms and seeking prompt medical care may influence outcomes and recovery.

Common stroke symptoms include:

Sudden numbness or weakness, especially on one side of the body (e.g. facial drooping, arm drifting)
Confusion or difficulty speaking
Vision changes in one or both eyes
Difficulty walking, dizziness, or loss of balance
Severe, sudden headache

Dr Teo Kejia (张哿佳医生)

Senior Consultant Neurosurgeon

MBBS (SG)MRCS (Edin)FAMS (Neuro Surg)FRCS Ed (Neuro Surg)IFAANS

Types Causes Risks Symptoms When to See a Doctor Diagnosis Treatment Complications Prevention FAQ Conclusion

What is a Stroke?

A stroke, sometimes called a “brain attack, deprives brain tissue of oxygen and nutrients. This can lead to brain cell injury within minutes. Medically, a stroke is classified as a cerebrovascular accident (CVA), a term used to describe conditions when blood flow to the brain is disrupted.

Stroke is a leading cause of long-term disability and mortality worldwide. While it can affect people of all ages, the risk increases with age. Stroke risk and patterns may vary among different populations, with certain ethnic groups having higher susceptibility to specific stroke types.

Types of Stroke

Ischaemic Stroke

Ischaemic strokes account for the majority of all strokes. They occur when a blood clot blocks or narrows an artery supplying blood to the brain. These blockages typically result from:

Atherosclerosis (the build-up of fatty deposits in artery walls)
Blood clots that travel from other parts of the body, particularly the heart

Haemorrhagic Stroke

Haemorrhagic strokes happen when a weakened blood vessel ruptures and bleeds into the surrounding brain tissue. This type accounts for a smaller proportion of strokes but is often associated with more severe symptoms. The bleeding causes swelling and pressure inside the skull, which can injure brain cells and surrounding tissue.

Transient Ischaemic Attack (TIA)

Often referred to as a “mini-stroke,” a TIA occurs when a blood clot temporarily blocks blood flow to the brain. The clot usually dislodges on its own, so symptoms typically resolve within minutes to hours without permanent damage. However, TIAs are serious warning signs, as people who experience one have a higher risk of a full stroke if not evaluated and managed promptly.

Primary Causes

Blood clots forming in arteries narrowed by fatty deposits (atherosclerosis)
Blood clots travelling from the heart or other vessels (embolic stroke)
Ruptured blood vessels due to uncontrolled high blood pressure
Weakened blood vessel walls (aneurysms)
Blood vessel malformations present from birth

Modifiable Risk Factors

High blood pressure (hypertension) may increase stroke risk
Smoking and tobacco use
Diabetes mellitus
High cholesterol levels
Obesity and physical inactivity
Excessive alcohol consumption
Atrial fibrillation (irregular heartbeat) and other heart conditions
Sleep apnoea (breathing repeatedly stops and starts during sleep)

Non-Modifiable Risk Factors

Age (risk may increase with advancing age)
Family history of stroke
Gender (risk factors may vary between men and women)
Previous stroke or TIA history
Ethnicity (risk may vary among different ethnic populations)

Signs & Symptoms

Early Symptoms

During the initial phase of a stroke, symptoms may appear suddenly and can include:

Sudden numbness or weakness in the face, arm, or leg, especially on one side
Sudden confusion or difficulty speaking
Sudden trouble seeing in one or both eyes
Sudden severe headache with no known cause

Peak Symptoms

As the stroke progresses, symptoms may intensify:

Complete weakness or paralysis on one side of the body
Loss of consciousness or reduced alertness
Severe difficulty understanding speech or speaking
Complete vision loss in one or both eyes
Loss of balance and coordination
Difficulty swallowing

Resolution Phase

In the hours following initial treatment:

Some symptoms may begin to improve with prompt medical intervention
Certain deficits may stabilise, while others continue to evolve
Outcomes differ among patients based on stroke severity and how quickly treatment was received

The acronym F.A.S.T. helps identify stroke symptoms: Face drooping, Arm weakness, Speech difficulty (such as slurred words or inability to repeat a simple sentence), and Time to call emergency services. Stroke symptoms vary depending on which part of the brain is affected.

Experiencing these symptoms?

Seek immediate medical care. Consult our brain surgeon for a comprehensive diagnosis and personalised treatment plan.

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When to See a Doctor

Stroke requires prompt medical attention. Call a healthcare provider immediately if you or someone nearby shows any stroke symptoms, even if they seem to fluctuate or disappear. Delayed stroke treatment may increase the risk of brain damage.

Seek immediate medical attention for:

Any sudden neurological symptoms (e.g., numbness, weakness, confusion, or difficulty walking), regardless of severity
Symptoms that appear and disappear (possible TIA)
Severe, sudden headache unlike any experienced before
Sudden difficulty with vision, speech, or movement
Loss of consciousness or altered mental state

After initial care, our neurosurgeon can conduct a comprehensive evaluation. Stroke risk factors and medical history are assessed, and a tailored prevention or treatment strategy is developed based on age, medical background, and lifestyle. Early intervention following a TIA or minor stroke may help reduce the likelihood of subsequent major strokes.

Diagnosis & Testing Methods

Clinical Assessment

Our A neurosurgeon begins with a thorough neurological examination, assessing reflexes, muscle strength, sensation, vision, and coordination. The National Institutes of Health Stroke Scale (NIHSS) helps quantify stroke severity and guide treatment decisions.

National Institutes of Health Stroke Scale (NIHSS)

The NIHSS is a test used to check how serious a stroke is. The test checks things like:

Awareness

Consciousness

coordination

Movement

Language and speech

senses

A higher score means the stroke is more serious

0 to 5

Minor stroke

6 to 15

Moderate stroke

16 to 20

modereate to severe stroke

21 to 42

severe stroke

A normal NIHSS score is 0.

A 42 may mean you’re in a coma. The exact symptoms you have at each severity level can vary.

Brain Imaging

CT (Computed Tomography) scans provide rapid images to distinguish between ischaemic and haemorrhagic strokes. This distinction is essential, as treatments differ between stroke types.

MRI (Magnetic Resonance Imaging) offers more detailed brain images, revealing minor strokes and identifying affected brain regions. Specialised MRI sequences may show brain tissue viability and help predict recovery potential.

Vascular Studies

Carotid ultrasound uses sound waves to examine the carotid arteries (major blood vessels that supply blood to the brain) in the neck for blockages or narrowing that could contribute to future strokes. CT or MR angiography provides detailed images of the brain’s blood vessels and may identify:

Aneurysms (weakened, bulging areas in vessel walls)
Arteriovenous malformations (abnormal tangles of blood vessels)
Vessel blockages

Cardiac Testing

Cardiac tests help to identify heart conditions that might contribute to embolic strokes (strokes caused by blood clots travelling from the heart to the brain):

Electrocardiogram (ECG): Records the heart’s electrical activity to detect irregular rhythms
Echocardiogram: Uses sound waves toimages the heart’s structure and function
Holter monitoring: Detects intermittent heart rhythm abnormalities like atrial fibrillation

Blood tests check for infection, blood sugar levels, kidney function, and clotting ability.

Treatment Options Overview

Emergency Medical Management	Acute ischaemic stroke treatment focuses on restoring blood flow quickly. Intravenous thrombolysis uses a medication called tissue plasminogen activator (tPA) to dissolve blood clots. This treatment is given within a limited time after symptom onset and may help improve outcomes. Rapid assessment and timely initiation of therapy are crucial for effectiveness.
Endovascular Procedures	Mechanical thrombectomy has transformed stroke treatment for large vessel occlusions (blockages in major brain arteries). Our neurosurgeon can use a thin catheter (flexible tube) inserted through the groin to reach the blocked brain vessel and remove the clot. This minimally invasive procedure can extend the treatment window for selected patients and may improve recovery.
Surgical Interventions	Haemorrhagic strokes (caused by bleeding in the brain) often require surgery to remove blood and relieve brain pressure. Craniotomy involves temporarily removing part of the skull to access the brain, evacuate clots, repair damaged vessels, or clip aneurysms (bulges in blood vessel walls). In some cases, less invasive techniques using endoscopes (thin tubes with cameras) or computer-assisted tools may minimise tissue disruption. For massive strokes causing dangerous swelling, a decompressive craniectomy may be performed to relieve pressure.
Rehabilitation Protocols	Comprehensive stroke rehabilitation begins during hospitalisation and continues through recovery. The multidisciplinary approach may include: Physical therapy aims to help restore movement and strength Occupational therapy aims to help regain daily living skills (e.g., dressing, cooking, or managing household tasks) Speech therapy to address communication or swallowing difficulties This coordinated care supports functional recovery and independence.

Every patient’s condition is unique.

Consult our neurosurgeon to assess your specific situation and discuss appropriate treatment options.

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Complications if Left Untreated

Without prompt treatment, a stroke may lead to significant brain damage. Brain cells can begin dying within minutes of oxygen deprivation (when the brain doesn’t receive enough oxygen-rich blood). As a result, the area of damage can expand rapidly. Untreated ischaemic strokes (strokes caused by blocked blood vessels) may also progress to haemorrhagic transformation, where damaged vessels begin to leak into surrounding brain tissue.

Physical complications may include:

Paralysis (loss of movement in parts of the body)
Muscle contractures (tightening and shortening of muscles)
Chronic pain syndromes

Cognitive effects can range from mild memory problems to more severe difficulties with awareness and thinking. Some individuals may experience speech problems, difficulty understanding language, or loss of communication abilities.

The impact of an untreated stroke can extend beyond physical and cognitive changes. Loss of independence and reduced quality of life are possible, with some individuals requiring long-term assistance for daily activities.

Individuals who have had a stroke face an increased risk of recurrent stroke without appropriate preventive treatment. Timely treatment may help improve the chance of recovery and help reduce the risk of long-term health complications.

Prevention

Primary Prevention Strategies

Controlling blood pressure may help lower the risk of stroke. Blood pressure targets are set based on individual risk factors, though readings below 130/80 mmHg are often recommended. These targets may be achieved through medication adherence, dietary adjustments, and regular exercise. Even modest reductions in blood pressure may help reduce stroke risk.

Lifestyle modifications can play an important role in stroke prevention:

Quit smoking, as stroke risk may decrease after quitting
Limit alcohol intake to moderate levels.
Maintain a healthy weight through balanced nutrition and regular physical activity.
Consider the Mediterranean diet, which is rich in fruits, vegetables, whole grains, and healthy fats and may help reduce stroke risk.

Medical Management

Managing underlying medical conditions may help prevent stroke. Diabetes control through medication and lifestyle changes is important. The HbA1c test (a blood test measuring average blood sugar levels over the past two to three months) helps assess long-term glucose control. Target levels are determined based on individual risk profiles.

High cholesterol may be treated with statins (medications that lower cholesterol levels). Appropriate LDL cholesterol targets (the level of “bad” cholesterol that can build up in arteries) are determined according to overall cardiovascular risk.

Heart rhythm abnormalities, particularly atrial fibrillation (an irregular heartbeat), may require anticoagulation therapy (blood-thinning medication) to reduce stroke risk.

Regular health screenings can help identify risk factors early and allow timely intervention. Annual assessments may include:

Blood pressure monitoring
Cholesterol panels (blood tests measuring different types of cholesterol and fats)
Diabetes screening

Carotid ultrasound screening (an imaging test that uses sound waves to examine blood vessels in the neck) may benefit high-risk individuals. Our neurosurgeon can assess your individual risk profile and recommend appropriate preventive measures tailored to your specific situation.

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Frequently Asked Questions

What is the difference between a stroke and a heart attack?

Both are medical emergencies caused by interrupted blood flow, but they affect different organs. A stroke occurs when blood flow to the brain is blocked or reduced, which can cause brain cells to die. A heart attack happens when blood flow to the heart muscle is blocked. Strokes often affect neurological functions, such as speech, movement, balance, or vision. Heart attacks typically cause chest pain, chest pressure, shortness of breath, or pain radiating to the arm or jaw. While both conditions require urgent medical care, stroke treatment focuses on restoring blood flow to the brain or controlling bleeding, whereas heart attack treatment aims to reopen blocked coronary arteries.

Can young people have strokes?

Yes, strokes can occur at any age, including in children and young adults. In younger individuals, strokes are often caused by different factors compared to older adults. These may include blood vessel abnormalities present from birth, heart defects, blood clotting disorders, substance use, or the use of oral contraceptives combined with smoking. Younger patients may have better recovery potential due to brain plasticity, but any sudden neurological symptoms should always be treated as urgent and require immediate medical attention.

How long does stroke recovery take?

Recovery time varies depending on stroke severity, location, and how quickly treatment was initiated. Most recovery occurs within the first few months, though improvements can continue for years. Mild strokes may allow return to normal activities, while more severe strokes often require prolonged rehabilitation. Physical therapy, medication adherence, and lifestyle modifications play important roles in recovery.

What are the chances of having another stroke?

The risk of recurrent stroke is higher without appropriate treatment and lifestyle changes, particularly in the days and weeks following the initial event. Risk reduction focuses on controlling contributing factors such as blood pressure, cholesterol, heart rhythm disorders, and diabetes. Medication adherence and lifestyle changes, including smoking cessation and regular physical activity, are important. Regular follow-up with our doctor helps ensure preventive strategies are tailored to your individual risk profile.

Is stroke hereditary?

Stroke itself isn’t directly inherited, but genetic factors can increase stroke risk. A family history of stroke may increase risk by contributing to conditions such as high blood pressure, diabetes, high cholesterol, or inherited blood vessel abnormalities. Some rare genetic disorders are associated with stroke, though these account for a small percentage of cases. Knowing your family history helps your doctor assess your risk and implement appropriate preventive measures. Even with a genetic predisposition, lifestyle modifications can help reduce stroke risk.

What should I do if someone is having a stroke?

Act F.A.S.T:

Face: Check for facial drooping
Arm: Check for arm weakness
Speech: Check for slurred or difficult speech
Time: Call emergency services immediately

Note the time symptoms started, as this information is critical for treatment decisions. Keep the person calm and lying down with their head slightly elevated. Don’t give them food, water, or medication. If they’re unconscious, place them in the recovery position.

Can stress cause a stroke?

Stress alone doesn’t directly cause a stroke, but chronic stress may increase stroke risk. Stress can raise blood pressure and contribute to unhealthy behaviours such as smoking, poor diet, and physical inactivity. It may also trigger inflammatory responses that affect blood vessels. In some individuals, severe acute stress may act as a contributing factor. Managing stress through regular exercise, adequate sleep, relaxation techniques, and professional support is an important part of stroke prevention.

Conclusion

A stroke can significantly impact brain function and daily living. However, advances in treatment have improved outcomes for those who receive timely care. Understanding stroke symptoms, risk factors, and the importance of immediate medical attention can save lives and preserve brain function. Our neurosurgeon combines experience with modern technology to provide comprehensive stroke care, including emergency intervention and long-term prevention.

Recovery from stroke may be possible with appropriate medical care, rehabilitation, and support. Outcomes differ among patients based on individual health factors. Treatment will be tailored to your specific needs and goals. Stroke prevention is equally important. Managing risk factors today may help protect your brain health tomorrow.

Take the First Step Towards Better Health

Living with stroke risk or recovering from stroke can be challenging, but you don’t have to face it alone. Our Senior Consultant Neurosurgeon has experience in diagnosing and treating stroke using evidence-based approaches.

If you have concerns about stroke risk or need care, consult our neurosurgeon to discuss individual circumstances and explore suitable prevention or treatment options.

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Dr Teo Kejia 张哿佳医生

Senior Consultant Neurosurgeon

MBBS (SG)●MRCS (Edin)●FAMS●FRCS Ed●IFAANS

Dr Teo Kejia is an experienced Senior Consultant Neurosurgeon and Director at Precision Neurosurgery.

Dr Teo has extensive knowledge and experience in the field of neurosurgery, with a particular focus on complex brain tumour procedures. He is adept in employing advanced surgical techniques, including brain mapping and awake brain surgery, especially for treating gliomas and glioblastomas. His expertise extends to neuro-oncology, encompassing both brain and spinal tumours, as well as neurovascular and skull base surgery.

Additionally, Dr Teo offers treatment for a range of neurological conditions, such as traumatic head injuries, intracerebral aneurysms, and degenerative spine disorders, which include neck and back pain. He is also proficient in managing ischemic and haemorrhagic strokes, hydrocephalus, trigeminal neuralgia, and hemifacial spasm.

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