Stroke: Recognising the warning signs



STROKE is a debilitating disease. It is one of the leading causes of death and disability in the world today.

Stroke is not really uncommon. It is estimated that one in six people is at risk of stroke. In the United States, stroke occurs every 40 seconds. The World Health Organisation (WHO) has reported that it is the second leading cause of death in the world.

In Malaysia, stroke has remained in the top 10 causes of mortality in this country for the last decade. It was reported that in 2007 alone, there were 52,000 hospital admissions for stroke across the nation, equivalent to six new cases every hour.

Stroke can occur at any age. However, it mostly affects the older age group with risk factors such as hypertension, diabetes, having irregular heart beat and other lifestyle-related conditions such as obesity, high level of cholesterol and cigarette smoking. A 2012 local study by Universiti Kebangsaan Malaysia (UKM) conducted at 10 selected public health centres or Klinik Kesihatan in Peninsular Malaysia revealed that the average age for onset of stroke was 56.3 years.

As more and more younger people are suffering from lifestyle-related illnesses, the number of stroke incidents in this age group is increasing.

Stroke is like a heart attack. It is caused by an interruption of blood supply to the brain rather than the heart resulting in damage to the brain tissue hence it is sometimes referred to as a “brain attack”.

This is normally due to either a blood clot or bursting of the vessel in the brain which causes a haemorrhage. Stroke is a life-changing event. Once you have a stroke, you can be partially or completely paralysed and have to depend on others for the rest of your life. You may have problems with basic daily functions like talking, eating, drinking, showering and even putting on your clothes; things that we normally take for granted. Not all stroke sufferers will remain disabled after the stroke. With appropriate early intervention and rigorous rehabilitation, a majority of stroke sufferers will regain their function.

The best treatment for stroke is to prevent it for happening. This can be achieved by controlling conditions such as hypertension, diabetes, having high levels of cholesterol, obesity and smoking – known as reversible risk factors. This can be achieved by choosing a healthy lifestyle.

In spite of this, if the stroke is detected early and given the appropriate medical treatment; it can be life saving or, at the very least, complications from stroke such as permanent muscle weakness or speech problems can be minimised to a lesser degree.

With the advancement of medical intervention in stroke therapy, there are more options of treatment that can be given to the sufferers in the hospital if presented at the early stages of the disease when the damage is still reversible.

Stroke patients who arrive for treatment at the hospital within three hours from the first stroke symptoms tend to have lesser disability compared with the patients who delay treatment. This duration of three to three and a half hours within the first stroke symptoms is often referred to as the “golden hour”, where treatment such as thrombolysis, a treatment to dilute the blood clot in the brain can be given to certain stroke patients to halt brain tissue damage from occurring.

So, the earlier the patient is brought to the hospital for treatment the higher the chances of recovery. Therefore, recognising the symptoms of stroke is paramount.

The severity of stroke tends to depend on the extent of the brain damage. Early symptoms can be very subtle and mild such as having only double vision or feeling slight numbness on one side of the face or body. On the other hand, in a later stage or in a more severe stroke, patients can present with severe headache or fainting.

Some of the common recognisable signs and symptoms that we should be aware of in people having a stroke are:

  • Sudden facial muscles weakness or numbness causing the face to droop to one side and this can be accompanied by drooling on the affected side.
  • Sudden weakness of the arms and legs. Patients will have trouble lifting their arms or walking. Their balance can also be affected.
  • Speech is normally affected, making it difficult to speak clearly. Most of the time the speech is slurred or with a different quality of sound.
  • They can be confused and unable to say their own name, the place they are at or even the time of day. They can also have difficulties in understanding what you are saying to them.

An easier way to remember or to test if a person is having a stroke is to remember “FAST”. Which stands for

F: Face – Ask the person to smile. Observe if there is a facial droopiness or drop to one side.

A: Arm – Ask the person to lift both of their arms in front of them.

Watch if they are unable to lift one or both arms or if one of the arms drifts downwards.

S: Speech – Ask the person to say a few phrases. Listen for a change or a strange quality of the voice. The voice may be slurred.

T: Time – Remember time is gold; if you see a person with any of these signs, you need to get him/her to the hospital for treatment as soon as possible. The easiest way is by calling an ambulance by dialling 999 or 112 from a mobile phone.

In a nutshell:

1. Stroke can cause death and permanent disability.

2. However, with early medical intervention these can be prevented.

3. Therefore you need to identify warning signs of stroke and get the person to a hospital for treatment as soon as possible.

Prompt response can make a huge and significant difference to someone’s life. So, if you see a person or even yourself having these symptoms, you need to act FAST.

Dr Mohd Fairuz Ali is a lecturer and Family Medicine Specialist at the Dept of Family Medicine, UKM Medical Centre. His area of interest includes raising community awareness on stroke and optimising community stroke care support for patients residing at home.


Health Facts 2013, Ministry of Health Malaysia.

World Health Organisation (WHO) | Stroke, Cerebrovascular accident

Krishnamoorthy, M. (2007). Killer stroke: Six Malaysians hit every hour (The Star)

Abdul Aziz, A. F. Abd Aziz, N. A., Sulong, S., & Aljunid, S. M. (2014).

Identifying post stroke patients in the Malaysian community: Profile of patients managed at 10 selected public health centres in Peninsular Malaysia. BMC Public Health, 14 (Suppl 1), P20. doi:10.1186/1471-2458-14-S1-P20

Impact of Stroke (Stroke statistics); American Stroke Association

Spot A Stroke; American Stroke Association

Stroke Facts; Centre of Disease Control And Prevention

What is Stroke? National Stroke Association

Stroke 101: Fast Facts on Stroke, National Stroke Association

Warning Signs Of Stroke; National Stroke Association

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