WORLD STROKE DAY
EVERY second counts when it comes to a stroke. For every minute that passes after the onset, approximately 1.9 million neurons are lost. Globally, stroke remains the second leading cause of death, with over 12.2 million new cases reported in 2019. In Malaysia, the numbers are equally concerning, with 47,911 new stroke cases and nearly 20,000 deaths recorded that same year.
Dr. Aaron Lai Kuo Huo, Consultant in Emergency Medicine, and Dr. Mohamad Imran Bin Idris, Consultant Neurologist, from Sunway Medical Center, Sunway City, explain that the first 72 hours after a stroke are critical for recovery. They emphasize the importance of rapid intervention, close monitoring, and a multidisciplinary approach to enhance outcomes and minimize long-term disability.
Why Every Minute Matters After a Stroke
While public awareness campaigns often emphasise recognising stroke symptoms through the B.E. F.A.S.T. acronym, what happens after a patient reaches the hospital is equally crucial.
“The first 72 hours can determine whether a person recovers fully or faces long-term disability,” said Dr Aaron. “When a stroke strikes, the brain is deprived of oxygen, and damage starts immediately. Quick interventions, like clot-busting drugs or thrombectomy, can save lives and preserve brain function, but these must happen fast.”
Studies show that patients receiving thrombolytic therapy within the first 4.5 hours of symptom onset have a significantly higher chance of functional recovery. This so-called ‘golden hour’ dramatically improves the likelihood of a full recovery.
The Importance of the First 72 Hours
A multidisciplinary team ensures immediate and effective treatment once a stroke patient arrives at the hospital. The first 72 hours, often called the “crucial window”, can mean the difference between life and death, or between full recovery and permanent disability.
“In these 72 hours, we focus on preventing complications like secondary strokes or brain swelling,” explains Dr Mohamad Imran. “After treatments such as thrombolysis or thrombectomy, we closely monitor the patient, often repeating brain scans within the first 24 hours to check for bleeding or other complications.”
During this time, key health factors such as blood pressure, blood sugar, and hydration are stabilised, as they play pivotal roles in reducing brain damage. Early rehabilitation is also vital. “The sooner we can begin therapy, usually within 48 to 72 hours, the better the patient’s chances of regaining mobility and independence,” Dr Mohamad Imran adds.
Success stories underscore the urgency of early stroke care. Dr Aaron recalls a young man in his late twenties who suffered a stroke after a gym session.
“He arrived at the hospital within an hour of experiencing left-sided weakness and slurred speech. Thanks to quick recognition and a fast response, we administered clot-busting therapy within 40 minutes. He regained full function within days and was discharged without lasting damage,” he shares.
Dispelling the ‘Mini Stroke’ Myth
One harmful misconception is that a “mini stroke” or transient ischaemic attack (TIA) is not serious. Dr Mohamad Imran warns against this false sense of security.
“I try not to use the term ‘mini stroke’ because it downplays the severity. Even with a TIA, the risk of having a full-blown stroke is very high, particularly in the first 48 hours. It’s crucial to treat any stroke symptoms urgently,” he says.
Dr Aaron adds, “Patients with a TIA must seek medical attention immediately, even if symptoms resolve quickly. Up to 1 in 5 patients with TIA will have a major stroke within 90 days, with half occurring in the first 48 hours.”
Stroke Rising Among Younger People
Strokes are increasingly affecting younger Malaysians, largely due to lifestyle factors such as poor diet, obesity, smoking, and physical inactivity. Studies show a 53.3% increase in strokes among men and 50.4% among women aged 35–39.
“We’re seeing more metabolic syndromes in younger people, and these are major contributors to strokes,” says Dr Aaron. “Younger patients often fail to recognise early symptoms or delay seeking treatment, leading to worse outcomes.”
A Holistic and Multidisciplinary Approach to Recovery
Effective stroke care extends beyond emergency treatment. A comprehensive, multidisciplinary approach, involving neurologists, physiotherapists, occupational therapists, and speech therapists, is key to long-term recovery.
“Stroke patients benefit enormously from early rehabilitation,” says Dr Mohamad Imran. “Whether it’s regaining the ability to walk, swallow, or speak, starting therapy as soon as the patient is stable maximises their chances of regaining independence.”
Family support also plays a crucial role. “Families are often guided on how to help their loved ones regain strength, manage medications, and cope with the emotional challenges of recovery,” he adds.
The Takeaway
The first 72 hours after a stroke are decisive in shaping a patient’s future. With stroke cases on the rise in Malaysia and worldwide, awareness of early symptoms, timely hospital care, and ongoing rehabilitation is more critical than ever. As Dr Mohamad Imran concludes,
“It’s not just about surviving a stroke, it’s about recovering with quality of life.”
