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Stroke Precursors? Accurate Diagnosis and Timely Treatment Are Essential

According to government data, stroke is the fourth leading cause of death in Hong Kong, claiming over 3,000 lives annually. Medically referred to as "cerebrovascular disease," stroke occurs due to blockage or rupture of blood vessels in the brain. Faced with this silent killer, what should one do if unfortunately afflicted?


Silent Onset of Stroke: Immediate Treatment Upon Symptom Manifestation

Strokes are generally classified into hemorrhagic, ischemic, and minor strokes. A neurosurgeon explains that ischemic stroke, also known as "thrombotic stroke," involves blockages in the neck or brain blood vessels, accounting for 70% of stroke cases in Hong Kong. Patients may experience mild dizziness or paralysis of the face or hands. Without immediate intervention, symptoms such as weakness and facial drooping can intensify within a day or two, leading to loss of sensation. Hemorrhagic stroke, commonly known as "burst blood vessel," typically involves the rupture of major blood vessels or aneurysms due to congenital abnormalities, accounting for 30% of stroke cases in Hong Kong. This type of stroke occurs without warning, potentially causing sudden headaches and loss of consciousness; minor strokes can be ischemic or hemorrhagic, generally milder and potentially resolving within 24 hours, though they can precipitate a major stroke.

To aid public recognition, the acronym "FAST" (Face, Arm, Speech, Time) is used to identify stroke symptoms. "Face" refers to facial muscles controlled by the seventh cranial nerve from the brainstem; asymmetry in the smile or facial drooping should raise an alarm. "Arm" involves weakness or paralysis observable when the patient attempts to use their limbs. "Speech" covers the speech areas in the left brain, where difficulties in articulation should prompt immediate concern. "Time" implies that if these symptoms are present, it is crucial to seek emergency help promptly. However, symptoms like dizziness and memory issues are not covered by "FAST." Despite the absence of these primary symptoms, it does not guarantee safety. Stroke symptoms are numerous, and conditions such as brainstem stroke can manifest similar symptoms, while viral infections can also affect facial nerves. Misdiagnosis based on facial drooping alone is risky, and any doubts should lead to immediate medical consultation.


Anyone Can Be at High Risk

It is believed that individuals with hypertension, hyperlipidemia, or diabetes ("the three highs") are at high risk for stroke, but many young patients do not exhibit these conditions. In reality, these are just among many risk factors, including congenital arteriovenous malformations, which can predispose individuals to stroke without a family history. Smoking accelerates the degeneration of cardiovascular and cerebrovascular systems, leading to thrombosis or aneurysms that may easily rupture. Additionally, lack of sleep can disturb the cerebral balance, increasing stroke risk. Some young individuals who regularly exercise and maintain a healthy diet might still suffer from "vascular dissection and occlusion" during physical activities.

In emergency settings, doctors first ensure the patient is conscious and breathing adequately. The "golden three hours" concept is well-known, suggesting that administering a clot-busting injection within three hours of stroke onset can help dissolve clots and salvage brain cells, reducing disability risks. However, this treatment, over a decade old, is not a cure-all and is only suitable for ischemic stroke patients. Using this treatment in hemorrhagic stroke patients can exacerbate bleeding; it can also worsen injuries in patients with vascular dissections involving neck to brain arteries.

From a clinical perspective, saline injections are more commonly used than clot-busting drugs to elevate blood pressure and alleviate blockages. If a stroke involves large blood vessels, patients may require a procedure known as thrombectomy. Currently, many suspected stroke cases rely solely on CT scans for diagnosis, which can delay the detection of ischemic strokes in the brainstem, thus postponing critical treatment. Even patients with minor strokes should undergo MRI to promptly identify and address the issues. Modern MRIs, which do not require contrast agents, can also detect congenital and acquired vascular abnormalities in cerebral and cervical vessels, playing a crucial role in accurate stroke diagnosis and early treatment.


Can Angong Niuhuang Pills Cure Stroke?

In recent years, Angong Niuhuang pills have become popular, believed to aid in vascular health and reduce stroke risk. However, for patients with hemorrhagic strokes, taking these pills can intensify bleeding. Even in ischemic strokes, while they may benefit microvascular circulation, they are ineffective if the ischemia involves major arteries like the cervical arteries and brain's aorta.

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