In the blink of an eye, he was gone. Iskandar (not his real name) collapsed in the toilet of a restaurant where just minutes earlier he was having a meal with his wife and four children.
Iskandar, who was only 48, told his wife he felt nauseous before heading for the restroom.
Sharing the family’s story with Bernama, consultant neurosurgeon Dr Nor Faizal Ahmad Bahuri said Iskandar was later found lying unconscious on the toilet floor.
By the time he was rushed to the hospital, he was already in critical condition, and a CT scan revealed bleeding in the brain.
“The patient underwent surgery but passed away within 48 hours,” the surgeon said.
Dr Nor Faizal, currently serving at KPJ Tawakkal Specialist Hospital Kuala Lumpur, said the incident unfolded very quickly, highlighting the importance of getting immediate medical attention when stroke symptoms appear.
WHAT IS HAEMORRHAGIC STROKE?
A haemorrhagic stroke claimed Iskandar’s life. While ischemic strokes – which happen when blood flow to the brain is blocked – are more common, haemorrhagic strokes occur when a blood vessel in the brain breaks and bleeds.
“A haemorrhagic stroke involves spontaneous bleeding in the brain caused by a ruptured blood vessel, which then disrupts brain function.
“This condition occurs when the blood vessel walls become thinner, and in most cases, it is triggered by high blood pressure,” Dr Nor Faizal explained.
Although people with hypertension are more prone to haemorrhagic strokes, he said those with diabetes and high cholesterol, as well as smokers, are also at risk.
Describing what it is like to experience a haemorrhagic stroke, he said: “Imagine being at Kuala Lumpur Sentral station, where many train services intersect. Suddenly, there’s a blackout, complete darkness. All train services come to a halt, everything is paralysed.
“That’s what it’s like when someone suffers this type of stroke. The person collapses instantly, and it happens in just a matter of seconds”.
SYMPTOMS
Dr Nor Faizal said it is crucial for the public to be aware of and be able to identify the signs of stroke so that prompt treatment can be given, potentially preventing the condition from worsening.
“A haemorrhagic stroke is often preceded by the typical signs of a regular stroke, such as drooping face, slurred speech and weakness or paralysis on one side of the body. All of these symptoms tend to occur very suddenly,” he said.
He explained that early warning signs of a stroke can be identified using the acronym ‘BE FAST’.
“B stands for balance – the person may suddenly lose their sense of balance. E is for eyes – they may experience sudden loss or blurring of vision.
“F refers to face – one side of the face may suddenly droop or appear uneven. A is for arms – the individual may be unable to raise both arms due to weakness or numbness,” he said.
The letter S, meanwhile, stands for speech, which may become slurred or incoherent, while T is for time – meaning the person must be rushed to the hospital as quickly as possible for emergency treatment.
“The sooner treatment is given, the more brain cells we can save,” he stressed.
TREATMENT
Dr Nor Faizal said a haemorrhagic stroke can only be confirmed through a CT scan because its symptoms are similar to other types of strokes.
“In terms of treatment, a haemorrhagic stroke requires immediate surgery to relieve pressure on the brain caused by sudden bleeding inside the blood vessels.
“Imagine the brain as a container with a limited capacity. When there is a sudden increase in blood volume, it puts pressure on the brain tissue, which can then stop functioning properly.”
He said surgical intervention is necessary to remove the accumulated blood and relieve the pressure. This is different from an ischemic stroke, where blood flow is blocked but there is no increase in blood volume within the brain.
“This is why the risk of death is significantly higher with a haemorrhagic stroke compared to a regular (ischemic) stroke,” he added.
When asked about cases where patients die before receiving treatment, Dr Nor Faizal said this often stems from a common misconception that strokes only cause weakness or partial paralysis.
“In reality, we cannot see what is happening inside a person’s head. That’s why anyone who shows signs of weakness should be taken to the hospital immediately so we can determine the type of stroke they are experiencing.
“For example, an elderly patient may already appear weak at home but with the children away at work, he or she may only be brought to the hospital later in the evening. By then, a brain haemorrhage may have already occurred – and at that point, it may be too late,” he said.
Dr Nor Faizal added that even if a haemorrhagic stroke patient survives, they may still face loss of bodily functions, whether permanently or temporarily.
“Patients often struggle with swallowing, speaking and maintaining awareness. Other complications, such as lung infections, may also arise afterwards,” he said.
He noted that strokes usually occur in people aged 40 and above, with men facing a higher risk than women.
“However, public awareness of haemorrhagic strokes remains very low,” he added.
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