Stroke Warning Signs Treatment in Johor Bahru

If you think someone is having a stroke right now, call **999** immediately. Do not drive them yourself if an ambulance can come. Do not bring them to a GP clinic — we cannot treat a stroke, and the minutes spent here are brain that does not come back. Most people know FAST. Malaysian stroke neurologists prefer **BEFAST**, because FAST misses a substantial group of strokes, and the ones it misses are the ones most often sent home. **B — Balance.** Sudden loss of balance, coordination or the ability to walk. Sudden severe dizziness that is new and unexplained. **E — Eyesight.** Sudden loss or blurring of vision in one or both eyes, or sudden double vision. **F — Face.** Sudden drooping on one side. Ask them to smile. **A — Arms.** Sudden weakness or numbness in one arm or leg. Ask them to raise both arms and hold them. **S — Speech.** Slurred speech, inability to find words, or inability to understand what is said. Ask them to repeat a simple sentence. **T — Time.** Note the time symptoms started and call 999. The B and the E are the additions that matter. Strokes affecting the back of the brain present with dizziness, unsteadiness and visual disturbance rather than a drooping face, and they are routinely mislabelled as vertigo, low blood pressure or exhaustion. A person who suddenly cannot walk straight, or who has sudden double vision, is having a neurological emergency until proven otherwise. Other sudden symptoms that count: severe headache with no known cause, particularly if described as the worst of their life; sudden confusion; and sudden numbness down one side. **The time the symptoms started is the single most valuable piece of information you can give.** Not when they were found — when they were last seen completely normal. Treatment eligibility depends on it. If someone wakes with symptoms, the relevant time is when they went to bed well.

This is the part almost no stroke page tells you, and in this country it changes outcomes. Ischaemic stroke — the type caused by a clot, and the large majority — can sometimes be treated by dissolving the clot with intravenous thrombolysis, or by physically removing it with mechanical thrombectomy. Both are extraordinarily time-dependent. Thrombolysis is given ideally within **4.5 hours** of symptom onset, and the first 60 minutes are described as the golden hour because outcomes are best when treatment starts within it. But not every hospital can do it. Of Malaysia's 142 MOH hospitals, only **29 — about 20% — offer intravenous thrombolysis**, and only **seven offer both thrombolysis and mechanical thrombectomy**. Nationally, just **10.7%** of ischaemic stroke patients receive thrombolysis and **3.6%** receive endovascular treatment. The practical consequence: a family who drives to the nearest hospital may arrive somewhere that cannot deliver the treatment, and the transfer that follows consumes the window. **This is the strongest argument for calling 999 rather than driving.** Ambulance crews know which receiving hospitals can treat stroke, they can alert the hospital before arrival so the team is ready, and they begin assessment on the way. A private car arrives unannounced at a department that may not be equipped. Every minute matters in a literal sense — brain tissue is lost continuously while a vessel stays blocked. Every hour of delay reduces the chance of walking out of hospital independently. If you are in Masai, Pasir Gudang or the surrounding area, calling 999 gets you to an appropriate facility. Do not wait to see if it passes. Do not wait for a family member to come home. Do not take a nap and see how you feel — sleeping through a stroke is a common and devastating error, and it is why the "last seen well" time so often ends up being the night before.

A transient ischaemic attack — a TIA, or "mini-stroke" — produces the same symptoms as a stroke but they resolve, often within minutes, and the person feels entirely normal afterwards. Because it goes away, it gets ignored. That is the most dangerous misunderstanding on this page. A TIA is a warning that a major stroke may be imminent. The risk is highest in the **first 48 hours to seven days** after the event. Someone who has a TIA on Monday and plans to mention it at their next routine appointment may have a completed stroke before that appointment arrives. A TIA needs urgent assessment — the same day. Not next week. The purpose is to find and treat the cause before the full stroke happens: an irregular heart rhythm, a narrowed carotid artery, uncontrolled blood pressure, diabetes or high cholesterol. Treatment after a TIA substantially reduces the chance of a stroke following it, and that is a rare and genuine opportunity in medicine. If symptoms have fully resolved but occurred at all — sudden weakness, speech difficulty, visual loss, facial droop, or unexplained loss of balance — go to an emergency department the same day. If they are happening now, call 999. Atrial fibrillation deserves specific mention here. It is an irregular heart rhythm that frequently causes no symptoms at all, it becomes more common with age, and it allows clots to form in the heart that travel to the brain. The strokes it causes tend to be severe. It is detectable on a simple ECG, and once found it is highly treatable — which is why a routine ECG done for an unrelated reason is one of the commonest ways a future stroke gets prevented. We do ECGs on site.

Stroke is the third leading cause of death in Malaysia, and the assumption that it is a disease of the elderly is now measurably wrong here. Incidence has been rising in the under-65s. The largest increases recorded were in the **35 to 39 age band — up 53.3% in men and 50.4% in women.** People in their late thirties, with young children and mortgages, having strokes. The reason is not mysterious. Successive National Health and Morbidity Surveys since 2006 have shown continuous increases in the risk factors that cause stroke: diabetes, high cholesterol and obesity. Malaysia now has diabetes in 15.6% of adults, with roughly 38% of those cases undiagnosed. Uncontrolled high blood pressure is the single largest contributor of all, and it produces no symptoms whatsoever until it produces a stroke. Which makes the prevention argument concrete rather than moralising. If you are over 30, the things that determine your stroke risk are mostly measurable and mostly modifiable, and almost all of them are silent: Blood pressure — the most important, and the one you cannot feel. It should be checked even if you feel perfectly well. Diabetes and cholesterol — both silent, both detected on blood tests, both treatable. Atrial fibrillation — silent in many people, found on an ECG. Smoking, which roughly doubles stroke risk and is the fastest thing on this list to change. Weight, physical inactivity and alcohol. A single visit covering blood pressure, an HbA1c, a lipid profile and an ECG establishes most of your stroke risk. We do all four on site. For anyone in their thirties or forties with a family history, or with any of the conditions above, that is not an over-cautious check — it is the population in which stroke is rising fastest.

Surviving the acute event is the beginning. What happens over the following months determines how much function returns, and a great deal of it is ordinary work done consistently rather than anything dramatic. Rehabilitation — physiotherapy, occupational therapy and speech therapy — produces the greatest gains in the first three to six months, though improvement continues beyond that. The single biggest predictor of a poor outcome is rehabilitation that stops early, and in Malaysia it often stops because of cost, distance or the assumption that recovery has plateaued. Secondary prevention is the other half, and it is the half most often neglected once someone is home and feeling better. Blood pressure control, antiplatelet or anticoagulant medication as prescribed, statin treatment, glucose control, and stopping smoking. Recurrent stroke risk is highest in the first year, and the medications that reduce it must be continued even when the person feels completely well. Stopping them because things seem fine is the commonest preventable cause of a second stroke. Practical problems that need naming rather than enduring: swallowing difficulty, which risks food entering the lungs and causing pneumonia; painful or stiff shoulder on the weak side; incontinence; and post-stroke depression, which affects a large proportion of survivors, is treatable, and is frequently mistaken for the person having "given up". Carers need support too. Fatigue and burnout among family carers are near-universal and rarely raised in a consultation unless someone asks. What a clinic like ours does in all this: manage the blood pressure, diabetes and cholesterol that determine whether it happens again; review medications and check they are actually being taken; monitor for depression; treat the ordinary illnesses that destabilise a stroke survivor; and coordinate with rehabilitation services. That is not the dramatic part of stroke care and it is where the second stroke is prevented. We are at No. 62, Jalan Kiambang, Taman Bunga Raya, 81700 Masai, Johor, open Monday to Thursday and Saturday 9AM to 9PM, Friday and Sunday 9AM to 3PM. Call +60 7-251 1162. **And to repeat the only sentence on this page that must not be forgotten: if it is happening now, call 999. Not us.**