Stroke was the third most common cause of death in Malaysia in 2023, according to the Department of Statistics Malaysia (DOSM), and it is predicted to climb to the second by 2040. If no preventive action is taken, one in four Malaysians could suffer a stroke by that year. The Ministry of Health (MOH) supports DOSM’s prediction, highlighting stroke as a major cause of mortality in its Clinical Practice Guidelines 2020, with ischaemic stroke being the most prevalent form. This alarming trend underscores the urgent need for effective prevention and treatment strategies.
Ischaemic stroke occurs when the blood supply to parts of the brain is obstructed, preventing brain tissue from receiving oxygen and nutrients, leading to cell death within minutes. This can result in various neurological effects, including muscle paralysis such as facial weakness and numbness, as well as speech difficulties, visual disturbances, gait imbalances, dizziness, and long-term muscle stiffness that may impair daily activities.
Sunway Medical Centre Velocity (SMCV) Consultant Neurologist and Internal Medicine Physician, Dr Kok Chin Yong, explains, “Ischaemic strokes can result from various conditions, such as the build-up of fatty deposits in arteries and many other factors that promote blood clot formation.”
Therefore, immediate medical attention is crucial to minimise brain damage and improve treatment outcomes and post-stroke recovery.
The importance of golden hour for stroke treatment
If a stroke occurs, time is of the essence, and every second counts. The acronym “BE FAST” is widely used to help identify stroke symptoms quickly, but equally important is the concept of “The Golden Hour”. This term refers to the critical time window from the onset of stroke symptoms to receiving treatment, during which medical professionals can restore blood supply to the brain after blood vessels become blocked. Timely intervention within this period can significantly improve the chances of recovery and reduce the risk of long-term disability or death, as around two million brain cells die every minute without blood supply.
Medical interventions during “The Golden Hour” include two key treatments: thrombolysis and mechanical thrombectomy. Thrombolysis involves administering medication to dissolve smaller blood clots in the brain and must be performed within 4.5 hours of stroke onset. This treatment significantly increases the chances of restoring blood flow to the brain and reducing the risk of permanent damage.
For stroke patients with larger blood clots, mechanical thrombectomy is performed. This procedure involves using a device to physically remove the clot, similar to a heart angioplasty. A neurointerventional radiologist uses stent retrievers to expand within the clot, allowing it to be pulled out along with the device, or aspiration catheters to suction the clot directly out of the vessel. Mechanical thrombectomy is most effective within six hours of stroke onset but can still be beneficial if performed within 24 hours in certain cases.
SMCV Consultant Radiologist and Neurointerventional Radiologist, Dr Rozman Zakaria, explains that mechanical thrombectomy can more thoroughly restore blood flow as it can fully remove the clot from the brain, thereby enhancing recovery outcomes.
Dr Rozman also highlights that if stroke patients do not receive treatment within the golden hour, the risk of severe brain damage, increased mortality, and long-term disabilities significantly rises. Delayed treatment reduces the effectiveness of interventions, making recovery more challenging and often resulting in permanent physical, cognitive, and speech impairments. This can significantly impact the quality of life for stroke survivors, affecting their independence and overall wellbeing. Therefore, immediate medical intervention during the golden hour is crucial for improving outcomes and reducing these adverse effects.
Studies have also shown that if thrombolysis is performed within the golden hour, it increases the likelihood of functional independence in stroke patients by 30 per cent at three months post-stroke, allowing them to manage daily activities with less assistance. On the other hand, mechanical thrombectomy can boost independence in nearly 50 per cent of stroke patients and reduce post-stroke symptoms in over 40 per cent of patients. Dr Kok also emphasises that both treatments aim to reopen blocked blood vessels and restore blood flow to the brain, and in some cases, a combination of both may be used to maximise recovery potential.
Rehabilitation and journey to recovery
Stroke treatment is not only about immediate intervention during the acute phase but also involves long-term rehabilitation to aid recovery. Dr Kok and Dr Rozman both stress the importance of not giving up on rehabilitation, despite the challenges and stigma associated with it. Rehabilitation aims to maximise recovery through brain neuroplasticity, where the brain forms new connections to compensate for damaged areas.
Dr Kok advises that while it is important to accept the reality of a stroke, patients should remain committed to their recovery.
“Rehabilitation can significantly improve quality of life and independence, reducing the need for assistance in daily activities.”
Dr Rozman echoes this sentiment, encouraging all patients to continue with rehabilitation to further improve their physical and cognitive abilities.
In addition to the importance of immediate treatment and rehabilitation, more advanced and innovative treatment strategies, such as non-invasive brain stimulation in the form of repetitive transcranial magnetic stimulation (rTMS), are now available and can be utilised to improve brain neuroplasticity, helping to expedite patients’ recovery trajectory.
Furthermore, daily lifestyle choices and diet are crucial for stroke prevention. Dr Kok shares that being physically active and consuming Omega-3-rich foods, including five or more servings of fish per week, can lower stroke risk by 60 per cent. Hypertension and diabetes are key risk factors, as they promote plaque buildup in blood vessels, potentially causing blockages in blood flow to the brain, leading to sudden stroke symptoms.
He also observes an increasing incidence of stroke among younger individuals, often linked to a sedentary lifestyle, smoking, undiagnosed hypertension, and obstructive sleep apnoea (OSA), which is common in overweight individuals and frequently goes unnoticed.
Overall, effective stroke treatment within the golden hour can significantly improve patient outcomes and reduce long-term disabilities. Patients must seek immediate medical attention if they experience stroke symptoms and continue rehabilitation post-treatment to enhance recovery. Each stroke case requires a tailored treatment approach, so consulting trusted medical professionals and physiotherapists is essential.
By understanding the importance of timely treatment at the onset of stroke and committing to rehabilitation, stroke patients and their caregivers can take proactive steps to improve their quality of life and independence.
