Three golden hours could save your life

PUBLISHED : Tuesday, 08 November, 2011, 12:00am
UPDATED : Tuesday, 08 November, 2011, 12:00am


Two years ago, Mr Mak had a stroke while dining at a Chinese restaurant. The 70-year-old's right arm and leg suddenly went numb, and he found it difficult to speak. His family rushed him to hospital.

Two hours and 50 minutes after the attack, he was injected with a blood clot dissolving agent that helped remove the blockage in one of the arteries on the left side of his brain. He recovered the next day and did not suffer any serious complications.

Mak is one of the few lucky stroke victims for whom prompt treatment averted devastating complications such as damaged brain cells, disability and even death.

Doctors say only 10 per cent of stroke victims receive treatment within three hours of an attack. Prompt treatment can reduce the risk of disability and death by 50 per cent. The failure of the majority to do so results from a lack of knowledge of stroke symptoms, says Dr Yannie Soo Oi-yan, a specialist in neurology at Prince of Wales Hospital.

To raise awareness of strokes and the importance of prompt treatment, a group of doctors and academics set up the Hong Kong Stroke Fund just over a week ago.

'Less than 3 per cent of the stroke patients in our hospital get treatment within the three golden hours,' Soo says.

'Showing only slight symptoms, patients are not sure whether they should go to the hospital, where they may have to wait for hours.

'Chinese are also conservative and reluctant to seek medical treatment. Some elderly people want to wait for their children to see them before they make a decision.'

Such dithering over seeking treatment can be deadly, says Dr Dawson Fong To-sang, a neurosurgeon and fund president.

He cites worrying statistics: stroke is the fourth leading cause of death in Hong Kong. Every year, 18,000 people suffer strokes, resulting in 3,500 deaths.

An estimated one in six Hongkongers - nearly 1.2 million - will suffer from a stroke at least once.

'The figure is staggering,' Fong says.

Equally worrying are the statistics that show Hongkongers' poor knowledge of the disease.

In a recent survey done by the Stroke Fund in collaboration with Polytechnic University, 91 per cent of 525 respondents aged above 18 could not identify all the symptoms of stroke.

These include severe headache, numbness and lack of strength in limbs, lopsided facial expressions and difficulty in speaking.

More than 70 per cent did not know all the risk factors for stroke, which are high blood pressure, high cholesterol, drinking, smoking and diabetes.

Stroke is an acute cerebrovascular disease that affects blood supply to the brain owing to the blockage or rupture of the brain's blood vessels.

But only 73 per cent of respondents knew this, with 19 per cent mistaking it for heart disease, and others thinking it was a disease of the limbs or even a psychiatric illness.

Eighty per cent of the victims suffer an ischaemic or acute stroke, caused by a clot in one of the brain's blood vessels, Fong says.

The remainder suffer a haemorrhagic stroke, which is caused by the rupture of a vessel.

Acute stroke victims need treatment within the 'three golden hours' - the intravenous injection of a blood clot dissolving agent like the one Mak received.

Failure to obtain such treatment can result in severe damage to the brain cells, as the blocked vessel is unable to transport blood and nutrients to the brain.

'In such cases, acute stroke can become haemorrhagic, which needs surgery and [has a death rate of 30 to 50 per cent],' Fong says.

He says severe complications of stroke include paralysis and impairment of memory and cognition. Some 30 to 40 per cent of victims lose the ability to take care of themselves, while 20 to 25 per cent of stroke patients die within a year after the attack.

Knowing the symptoms of stroke and reacting quickly can help avoid these complications.

Neurologist Dr Huang Chenya, vice-president of the Stroke Fund, says people should be aware of even minor symptoms, such as severe headaches.

'While some patients will have severe symptoms, like being unable to move the legs or loss of consciousness, some show only minor symptoms, such as slightly slurred speech, at the outset,' he says. 'Those with minor symptoms may fail to respond quickly and suffer dire consequences.'

Fong says given Hong Kong's small size, patients should be able to get hospital treatment promptly.

'Hong Kong is not like Australia, where you have to drive for two hours [to get to a hospital],' he says.

He relates the example of a doctor who had a headache during a banquet. Instead of taking immediate action, the doctor decided to finish dancing.

The doctor later collapsed while driving and lapsed into a coma. He was eventually diagnosed as having had a stroke.

'It's like a scenario where the water pipes burst in your house,' Fong says. 'Delayed action means all the carpets and furniture are destroyed.'


- Estimated number (millions) of Hongkongers who will suffer a stroke at least once in their lives