​Intracerebral Haemorrhage (Stroke)​

Stroke represents a disorder of the cerebrovascular system (brain and blood vessels) which affects the blood supply of your brain. There are two major types of stroke, <Ischemic> and Haemorrhagic. It is the leading cause of disability across the globe, more common in men than women and can be life-threatening. The haemorrhagic type accounts for approximately 20% of all strokes, which includes intracerebral haemorrhage and <subarachnoid haemorrhage>. 

Let us take a look at the events leading to a stroke. Brain cells (neurons) are completely dependent on their arteries to bring them nutrients and oxygen. If this supply is cut off even for a few minutes, the brain cells are permanently injured and die. Consequently, the respective body function controlled by the damaged nerves is lost. 

Intracerebral haemorrhage occurs due to bleeding into the brain from a diseased blood vessel which leaks or ruptures. Uncontrolled high blood pressure is the most common underlying cause. Additionally, injury to the head, inflammation of blood vessels, brain aneurysm (weak vessel walls), overtreatment with blood thinning medication and drug abuse (cocaine or amphetamine usage) are also recognized causes of brain haemorrhage. The pooling of blood between the neurons exerts harmful effects by compressing them and blocking their fresh blood supply.  ​

Smoking, excessive alcohol intake, uncontrolled diabetes, high cholesterol, being overweight, heart disease, diseased carotid artery, sedentary lifestyle and age above 55 years are well-known risk factors of stroke.​​

In the event of an intracerebral haemorrhage, you may notice a sudden onset of:​

  • Weakness in arm and/or leg on one side of the body

  • Paralysis of face, arm or leg, particularly on one side 

  • Dizziness

  • Loss of balance when walking 

  • Slurred speech or loss of ability to speak

  • Blurry or double vision – there may even be complete blackout in one eye

  • Severe headache with vomiting​

If you suspect a stroke by noticing any of the above mentioned symptoms, do not waste any time in rushing to the <24/7 Emergency & Acute Care Service Line> at The Aga Khan University Hospital. Urgent medical attention is crucial for survival and prevention of permanent disability. Here is an easy pneumonic to help you identify the signs in yourself and others = BE FAST, which stands for:

  • Balance – is lost suddenly on walking or even standing

  • Eyes – sudden complete loss of or blurry vision; seeing double

  • Face – drooping of one side of face when you ask the suspected person to smile

  • Arms – try to raise both of your arms (or ask the affected person to raise their arms). One arm would drift downwards involuntarily 

  • Speech – slurred or strangely unrecognizable 

  • Time – every minute counts. Go to the <24/7 Emergency & Acute Care Service Line> immediately.​

Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.

Your health care provider at the <24/7 Emergency & Acute Care Service Line> at The Aga Khan University Hospital will ask you a few questions and perform a physical examination to determine what type of stroke you may be having and which section of your brain may be involved. A CT (Computerized Tomography) scan and some blood tests will most likely be ordered. This initial evaluation will assist to confirm your diagnosis and rule out other disorders that can mimic a stroke. 

The next step may include the <Mind and Brain Service Line> of The Aga Khan University Hospital to provide you with specialized care. Further testing may be done at a later stage to monitor your progress or find the causative factor. As the root of stroke is essentially a disorder in your cardiovascular system, these tests may include:

  • MRI (Magnetic Resonance Imaging) of brain – to look for any damage to brain from infarcts (dead tissue due to loss of blood supply) or other abnormalities 

  • Echocardiography – to gauge the structure and functionality of your heart

  • Carotid ultrasound – to identify any irregularity in the walls of the carotid arteries in your neck, as these are a frequent site of thrombus formation (blood clot due to build-up of fat) 

  • Holter monitoring – records the rhythm of your heartbeat continuously over 24 hours. You are sent home with a small portable monitor attached to your chest with wires for accurate day and night monitoring.  

  • Cerebral angiogram – to reveal any abnormality in the blood vessels of the brain itself​

The first line of management will be to control the bleeding in your brain. Medications may be given to control your blood pressure or, if you were taking blood thinning medications previously, their effects will be counteracted. The blood pooled in your brain will gradually heal like a bruise. However, surgical drainage may be required if the collection of blood is large. Surgery might also be indicated for blood vessel repair. ​

Another vital aspect of management is controlling risk factors through lifestyle changes and medications to reduce the chance of facing another haemorrhage. Thus, during your stay at The Aga Khan University Hospital medicines may also be initiated to target your cholesterol level or other issues that negatively affect your cardiovascular system. 

The consequences of stroke can be quite debilitating and scary. The Aga Khan University Hospital is the only internationally accredited hospital in Pakistan and it provides you with a platform for multidisciplinary care under one roof, to facilitate optimal health care. If you are diagnosed with a haemorrhagic stroke, the long term goal will be to help you regain the body functions which have been lost or become weakened. The faculty in all service lines consist of highly trained professionals who will support you through the rehabilitation process via:

  • Physiotherapy to regain lost body function

  • Occupational therapy to learn how to effectively live and work with any residual disability

  • Speech therapy, or alternative forms of communication to counteract loss of ability to speak clearly​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.​

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.​

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.​

The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.