Hypertensive Intracerebral Haemorrhage in Sharjah

What is hypertensive intracerebral haemorrhage?

Hypertensive intracerebral haemorrhage is a type of stroke in which a small artery deep inside the brain bursts and blood collects within the brain tissue. Years of raised blood pressure weaken the walls of these tiny vessels until one gives way.

These bleeds favour particular places: the deep areas that control movement and sensation, the brainstem and the cerebellum at the back of the head. That is why sudden weakness down one side of the body is such a common first sign.

At Dar Al Kamal Hospital, Sharjah, treatment brings together the emergency department, the consultant neurosurgeon and the intensive care team, followed by rehabilitation and lifelong blood pressure care.

Who needs it

This care is for anyone with a suspected bleed in the brain, most often a person with high blood pressure that has been untreated or poorly controlled. Many people in the UAE have high blood pressure without knowing it, because it usually causes no symptoms until damage has been done.

Call an ambulance immediately if someone suddenly develops any of these: weakness or numbness of the face, arm or leg on one side; a drooping face; slurred or confused speech; a sudden severe headache; vomiting; loss of balance; drowsiness or collapse. Note the time the symptoms began, since it guides treatment.

A bleed and a blocked artery cause very similar symptoms, and only a brain scan can tell them apart. A CT scan on arrival shows a bleed within minutes of scanning. This matters because clot-dissolving treatment used for blocked-artery strokes would make a bleed worse. Blocked-artery stroke care is covered under stroke treatment.

What happens

Treatment moves quickly through several steps at once:

• Blood pressure lowering. Medicines given through a drip bring the pressure down steadily, to reduce the chance of the bleed growing.
• Reversing blood thinners. If the person takes an anticoagulant, the team gives treatment to restore normal clotting.
• Close monitoring. Patients are cared for in neurological critical care, with frequent checks of alertness, pupils, breathing and limb strength, and repeat scans if anything changes.
• Supportive care. Swallowing is checked before anything is given by mouth, blood sugar and temperature are kept steady, and seizures are treated if they occur.

The neurosurgeon reviews every scan. Many bleeds are managed without an operation while the body gradually absorbs the blood. Surgery is considered when a large clot is pressing on the brain and the person's condition is worsening, and especially when the bleed is in the cerebellum, where swelling can squeeze the brainstem. A craniotomy lifts a section of skull to remove the clot. If blood blocks the fluid pathways and causes hydrocephalus, a thin tube called an external ventricular drain releases the pressure.

Preparing for it

A brain haemorrhage is an emergency, so preparation falls to family members. The most useful information is the time symptoms started, the person's usual level of independence, their medical history and every medicine they take, especially blood thinners and blood pressure tablets. Bring any previous blood pressure readings, scans and discharge letters. Share any wishes the person has expressed about their care, and keep a family contact available for the team.

Afterwards

Recovery continues for months. Neurorehabilitation begins as soon as the person is stable, with physiotherapy for movement and balance, speech and language therapy for communication and swallowing, and occupational therapy for daily tasks.

Long-term hypertension management is the most important step against a second bleed. That means regular home blood pressure checks, taking medicines every day, cutting down on salt, which is high in many restaurant and takeaway meals, regular activity as able and stopping smoking. Discuss Ramadan fasting and the timing of blood pressure tablets with your doctor well before the month begins, and keep hydrated in the heat.

Call an ambulance or go to the emergency department straight away if new weakness, speech difficulty, a severe headache, repeated vomiting, drowsiness or a seizure appears, even if it seems to settle. Contact the hospital if home blood pressure readings stay well above the target your doctor set, or if you have side effects from your medicines.

Cost and insurance

Emergency treatment for a brain haemorrhage is generally covered by UAE insurance plans, with the hospital notifying the insurer on admission. Rehabilitation sessions, home equipment and long-term medicines usually need separate approval, and some plans limit therapy sessions. Dar Al Kamal Hospital, Sharjah can help your family with approvals on 06 599 7777.