Stroke risk screen

The Stroke Risk Screen is a focused cardiovascular assessment aimed at identifying individual risk factors for stroke, particularly in those with predisposing conditions.

Ultrasound duplex evaluation of carotid and vertebral arteries
Echocardiogram and cardiac rhythm assessment
Stroke risk scoring and advice on targeted lifestyle changes for stroke prevention

The risk of stroke – which is due to the death of a part of the brain from either clots or bleeding in the circulation within the brain – is common in Asia. Women are more likely to have a stroke than men, and high blood pressure as well as high variability in blood pressure across the day is the most important risk factor in Asia. Clots may also form within the heart from irregular heart rhythms (Atrial Fibrillation) or from cholesterol deposits in the arteries in the neck that carry blood to the brain (carotid and vertebral arteries). Brain aneurysms – small swellings in the brain circulation that can bleed and cause stroke or death – are most seen in those with high blood pressure and smokers or those with a history of a brain bleed in a close relative. They are more common in women.

A stroke can cause significant health challenges with a loss of the ability to stay mobile, self-care and feed and even death. The financial burden as well as the care burden on people and their families can also be significant. The best approach to the risk of stroke is to prevent it as far as possible by screening for underlying diseases like cholesterol plaques in the carotid arteries, heart rhythm abnormalities and carefully managing any risk factors. This means obesity, diabetes, high and swinging blood pressure, smoking and abnormal blood cholesterol patterns (lipid profile).

Our stroke risk screening program is designed to identify any potential risks in the circulation that may cause a stroke, address lifestyle risk factors and recommend solutions to reduce stroke risk in individuals.

Who is this screen for?

If a close family member has had a stroke in the past, if you are on blood pressure or cholesterol controlling medication and have not had a stroke risk assessment before, if you are or have been a smoker in the past, are a diabetic or overweight especially around the middle – then this screening program is for you.

What tests does this screen contain?

Nurse assessment

For body composition measurements, BP, a CHA2DS2-VASC stroke risk score assessment and medication record.

Urine test

For blood cells, sugar and protein.

Blood tests

Full blood count – low haemoglobin levels affect the ability of the circulation to carry oxygen; High white cell counts can signify infection.
Glycated haemoglobin or HbA1C – a measure of average blood sugar control over 3 months
Kidney function – poor kidney function can develop from a variety of circulation-related mechanisms
Liver function
Clotting profile with Prothrombin time and thromboplastin time – to assess how well the clotting mechanism is functioning.
Lipid (cholesterol) profile – to assess circulation health.
CRP – The high-sensitivity C-reactive protein (CRP) test is a protein that measures general levels of inflammation in your body and is a marker for the risk of cardiovascular events like stroke.

ECG

Echocardiogram

A check to rule out asymptomatic heart valve issues or regions of abnormal contraction of the heart muscle that can lead to a clot forming and travelling to the brain and cause a stroke.

Carotid and vertebral artery ultrasound duplex scan

A non-invasive assessment of the arteries to the brain, to look for abnormal narrowing and cholesterol deposits.

Consultation with a senior specialist vascular surgeon

To discuss results and identify any risk factors early and institute changes to medication and lifestyle to reduce the risk of stroke.

An MRI or CT of the brain (usually needs radiological contrast dye) is not a routine part of our stroke screen due to cost, and exposure to radiation (in CT scans) and the very small, yet real the risks of contrast allergy or toxicity. However, if the risk factors for a brain aneurysm are present (smoking, high blood pressure with swings in BP and a family history of a brain bleed), then we may recommend a brain scan. This is not a part of this screening package.

How do I prepare for this screen and how long does it take?

If you have booked this screen, you should have received instructions on what to expect on-email or phone. If not, please call the clinic at least 1 day before the screen on +65 64720503 during working hours to confirm the instructions.
The screen is conducted over 2 days. Plan about 4 hours in the clinic on the first day and about 1 hour on the second day.
You will need to come in the morning on Day 1 having fasted (without having had anything to eat) for at least 6 hours.

What can I expect on the screening days?

On Day 1 of the screen, you will first be registered for the screening.
You will then have your blood tests as you are fasting.
You may then go and have breakfast and return to clinic where you will have the nurse assessment.
All remaining tests will be done after that and should usually be completed on Day 1. Day 1 may need up to 4 hours to complete.
On Day 2 (which can be scheduled to your convenience) but would be at least 3-5 days after Day 1 to allow for all test results to come back in), you will see the specialist vascular surgeon for a consultation and discussion. Day 2 may need up to 1 hour to complete. Please eat and drink as normal on Day 2.

What if my screening detects a problem?

We will give you a detailed report and recommendations in writing to take away.
We will also discuss your risk of a stroke and whether a brain MRI or CT scan is recommended for you.
If screening results suggest you need further investigations or treatment, you will also be given a note for you to show your family doctor to make a formal referral to us. Further treatments or tests may not be covered by insurance if there is not a formal referral.
Your screening results and reports are NOT shared by us with your doctor or any third party including your insurers or employers. Sharing your report results with other doctors, insurers or employers is for you to do as you deem fit but is recommended.

How often is a stroke risk screen needed?

This stroke screen is needed once in your forties, once in your fifties and perhaps every 5 years after that. However, if a specific heart or circulation disease that puts you at a high risk of stroke is detected, then targeted and more frequent tests and assessments may be needed. Any further follow up and treatment, if required, will depend on what the initial screening tests show.

you are covered

We are on the panel with most insurers in Singapore and with many international insurers; We also offer convenient options for self-paying patients.