Earlier this year, L.T.H. from Hong Ha ward in Hanoi planned to take her parents, who are in their 60s, and her husband, for stroke screening. She often felt anxious after reading social media posts about people suddenly dying from stroke despite appearing healthy. The topic even came up frequently at family meals. To reassure everyone, she suggested screening, believing “no amount of money is worth more than health”.

She was advised on a screening package including brain Magnetic Resonance Imaging (MRI), carotid angiography, CT scan, vascular ultrasound, electrocardiogram, ABI/TBI index measurement (ankle-brachial index), genetic mutation testing, fundoscopy, and blood tests, costing 25 million VND. For the four adults, it cost about 100 million VND.

"Prevention is better than cure; if the disease comes and we cannot react in time, we will regret it for a lifetime," she said.

Nguyen Huy Thang, chair of the HCMC Stroke Association and head of the Vascular Pathology Department at People's Hospital 115, said that specialized imaging techniques like brain MRI or cerebral angiography are usually only indicated when doctors suspect abnormal signs or when stroke symptoms have already appeared. Applying these methods in large-scale screening for completely healthy people sometimes does not bring many benefits.

He said over-screening can even lead to incidental findings that cause unnecessary anxiety. For example, about 3 percent of the population may have small brain aneurysms, but most are benign and the risk of rupture is very low, especially when the size is under 5mm.

“If such small aneurysms are detected, many people may experience prolonged anxiety. They may constantly fear stroke and even avoid walking due to fear of rupture,” he said.

Some individuals may also undergo early intervention when it is not truly necessary. In such cases, certain cerebrovascular procedures carry risks, with complication rates around 1–2 percent, sometimes higher than the natural rupture risk of small aneurysms.

Nguyen Tien Dung, deputy director of the Stroke Center at Bach Mai Hospital in Hanoi, said many people are willing to spend large amounts of money on screening in the hope of ensuring they will never have a stroke. However, this belief is incorrect.

According to recommendations from professional organizations such as the American Stroke Association, the European Stroke Organisation and the World Stroke Organization, screening should focus on identifying underlying risk factors rather than chasing advanced diagnostic technologies.

“There is no such thing as a 256-slice CT scanner being better for screening than a 64-slice one. Stroke screening is about identifying and controlling risk factors, not guaranteeing that someone will never have a stroke,” he said.

How is appropriate screening performed?

In principle, Thang believes that community stroke screening only needs to focus on major risk factors. 

A basic health check-up package can detect most risks leading to a stroke. 

Simple checks such as blood pressure measurement, blood sugar tests, blood lipids, and electrocardiograms to detect heart rhythm disorders can help identify about 80–90 percent of future stroke causes. Even heart rate monitoring can be done using smart devices like phones or smartwatches, helping early detect abnormal heart rhythms.

Dung said that factors such as age, gender, or race can impact stroke risk. Asians, including Vietnamese, have a higher risk of stroke compared to some other regions. But if each person controls risk factors well, the worry over the burden of this disease will decrease.

Long-term smokers should have a carotid ultrasound to detect stenosis or atherosclerosis, the factors that increase stroke risk. The process of vascular damage often occurs silently over many years, like a water pipe rusting over time. When blood vessels become atherosclerotic, the risk of forming blood clots causing vessel blockage or rupture leading to a stroke will increase.

“Emergency doctors are only the firefighters when a stroke occurs. In reality, the most important strategy remains disease prevention. Good prevention will help reduce the burden of illness, lower treatment costs, and reduce pressure on the healthcare system,” Dung said.

Vo Thu