World Stroke Day: know the signs, act fast, save a life

One day, she was going about her life. Then, in an instant, everything changed. The hair salon owner, in her early 50s, suffered a major stroke, leaving her unable to speak or respond.

By the time she reached the hospital, the 4.5-hour window for clot-busting medication had passed. Doctors removed the blockage through a mechanical thrombectomy, but she remained critically ill in intensive care, reliant on a feeding tube and a tracheostomy.

Her story is a sobering reminder that a stroke can upend an ordinary life without warning. And according to neurologist Hoo Fan Kee, it is no longer a condition associated only with old age.

“People tend to think that a stroke is something that happens only to the elderly, but that is not true,” Hoo told FMT Lifestyle.

“We have about 50,000 new stroke cases in Malaysia. The number has been increasing every year, and we’ve been seeing more and more younger patients … it is quite alarming.”

The National Stroke Registry recorded that 45.9% of patients between 2017 and 2024 were younger than 60, while 12.7% were below 45. Hoo, president of the Malaysia Stroke Council, pointed to obesity, sedentary lifestyles and metabolic problems as contributors.

The registry also found that 71% of registered stroke patients had high blood pressure and 40% had diabetes. Smoking and vaping are additional concerns, Hoo said.

While a stroke can strike suddenly, its risk factors often develop over years. Many, however, can be addressed through everyday choices.

“Weight management is one of the keys,” Hoo, said, recommending a healthy body mass index of 18.5 to 22.9 for Asian populations.

“A healthy diet is the way to go. Many studies have proven that the Mediterranean diet is very effective for prevention.”

To that end, Hoo advised eating more fibre, vegetables, fruits, whole grains, beans and nuts, alongside healthy oils such as olive oil.

“Our diet is quite salty, very sweet and oily,” he said. “We should reduce salt to less than five grams per day.”

Hoo recommends at least 150 minutes of moderate aerobic exercise weekly, resistance training twice a week and seven to nine hours of sleep nightly. Regular health screening for blood pressure, blood sugar and cholesterol is also important.

But prevention is only part of the equation. Recognising the warning signs and acting quickly can make a critical difference. Hoo urges the public to remember BE FAST: Balance, Eyesight, Face, Arm, Speech and Time.

“The golden hour is only 4.5 hours,” he said, referring to the standard window for eligible patients to receive clot-busting medication. Some patients with large clots may qualify for mechanical thrombectomy, depending on their condition and brain imaging.

Yet, getting treatment quickly is not always straightforward. Hoo cited Malaysia’s ratio of just 0.43 neurologists per 100,000 people. “To tackle this problem, we have to empower internal medicine and allow emergency physicians to get involved in acute stroke treatment,” he said.

Thrombectomy services remain concentrated in the Klang Valley. Data from 2022 and 2023 showed only 3% of Malaysian ischaemic stroke patients received clot-busting treatment, compared with 12% in Thailand.

Recovery can be a long journey, too. Hoo said Malaysia lacks sufficient rehabilitation centres and beds, leaving families to shoulder much of the burden.

“The golden period for rehabilitation – especially the first month, and up to nine months – is very important,” he said. “We do see a lot of improvement with intensive rehabilitation.”

Families must learn new caregiving skills while adjusting to sudden changes in their lives. The hair salon owner’s husband’s determination helped her regain some independence, but her journey also demonstrates that stroke care must continue beyond the hospital emergency department.

“About six months after the stroke, she could walk slowly, and her husband took her to a park each evening. She could also shake hands and recognise the nurses who cared for her,” shared Hoo.

For him, the message is clear: “Prevention is the way to go, not until they get a stroke. If they do suffer a stroke, recognise the BE FAST symptoms and go to the right hospital as soon as possible.”

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