​Ischemic Stroke​

Stroke represents a disorder of the cerebrovascular system (brain blood vessels) which affects the blood supply of your brain. There are two major types of stroke: Ischemic and <haemorrhagic>. Stroke is the leading cause of disability across the globe and can be life-threatening. The ischemic type accounts for more than 80% of all strokes and in general, both types are more common in men than women. 

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. 

Ischemia (loss of adequate blood supply) occurs due to a blockage of the brain arteries by a blood clot. The blood vessels distributing fresh oxygen to this vital organ, which controls and coordinates all your activities, are quite narrow in diameter. A blood clot can form in these tiny arteries due to build-up of fat (called a ‘thrombus’) in their walls. When a clot forms in the vascular system outside the brain, especially the heart, it can get transported to the brain and get stuck in those minute passages. This travelling clot is known as an ‘embolus’. Uncontrolled cholesterol levels raise your chances of being afflicted with an ischemic type of stroke. Atherosclerosis (cholesterol fat deposits in arterial walls) gives rise to plaques which make the respective vessel stiff and narrow.  

An <arrhythmia> of your heart is another causative factor. The rate and pattern of regular heartbeats are finely tuned. If this delicate balance is disturbed your heart will not be able to pump appropriately. This is also a recognized source of an embolus to your brain. Smoking, excessive alcohol intake, uncontrolled diabetes, high blood pressure, being overweight, heart disease, diseased carotid artery, sedentary lifestyle and age above 55 years are well-known risk factors of stroke. ​

Global cerebral ischemia is decreased blood flow to the whole brain. This usually takes place due to heart attack (myocardial infarction), abnormal rhythm of the beating heart or heart failure. Once again, the lack of fresh blood necessary to maintain the brain’s metabolic demands can lead to a stroke.​​

In the event of ischemic stroke, 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 and 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 of strangely unrecognizable 

  • Time – every minute counts. Go to the <24/7 Emergency and 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 and Acute Care Service Line> will ask you a few questions and perform a physical examination to determine what type of stroke you are 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, for the provision of specialized care.​

The first line of management will be to open the arterial occlusion in your brain to renew adequate blood supply. An initial CT (Computerized Tomography) scan of the brain will be done to exclude an intracerebral haemorrhage and then special medications labelled as clot busters or intravenous Tpa (tissue plasminogen activator) shall be administered to break up the clots. These can only be given within the first three to four and a half hours after the onset of symptoms, so make sure you reach the <24/7 Emergency and Acute Care Service Line> at The Aga Khan University Hospital at the earliest. Further treatment may involve:

  • Anti-platelet therapy: oral pills such as aspirin to prevent recurrent/future clot formation

  • Anti-coagulant therapy: injections (heparin for example) might be given to stop clumping of blood components

  • If necessary, your blood pressure and blood sugar level will be controlled with medications​

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 and admission in the stroke unit. If you are diagnosed with an ischemic stroke, it is imperative to locate the source of the blood clot. Further testing may be done at a later stage by the <Mind and Brain Service Line> at The Aga Khan University Hospital 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

  • 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.  

  • 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)

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

Carotid endarterectomy is a surgical procedure which relieves the obstruction in carotid arteries from plaque formation. These specific vessels extend straight into the skull passing through your neck and are a common site of atherosclerosis. If the carotid(s) is found to be affected, your doctor may suggest this surgery. 

Certain oral medications to control heart rhythm, lower cholesterol and avoid clogging of blood may be prescribed for long term management. The subsequent target will be to help you regain the body functions which have been lost or become weakened. The faculty in all service lines at The Aga Khan University Hospital consist of highly trained professionals who will support you through the rehabilitation process via and:

  • 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.