Hemorrhagic Stroke

Question 1

Hemorrhagic strokes

Answer 1

are caused by bleeding into the brain tissue, the ventricles, or the subarachnoid space. Clinical manifestations of hemorrhagic stroke are similar to those of ischemic stroke. In addition to numbness or weakness of the face or extremities (usually one side), confusion, cognitive deficits, expressive or receptive deficits, expressive or receptive aphasia, visual disturbances, ataxia, and dizziness, the patient may experince a sudden and severe headache, vomiting and focal seizures.

Question 2

Intracerebral Hemorrhage

Answer 2

(bleeding into the brain tissue) is most common with patients with hypertension and cerebral atherosclerosis. Because as the disease worsens it can cause the blood cells to rupture. It may also result from arterial patholofy, brain tumors and the usee of medications (anticoagulants, amphetamines, and illicit drugs).

Question 3

Cerebral Atherosclerosis

Answer 3

is the result of thickening and hardening of the walls of the arteries in the brain. Symptoms of cerebral arteriosclerosis include headache, facial pain, and impaired vision.

Question 4

Cerebral Amyloid Angiopathy

Answer 4

is the build up of beta-amyloid protein in the small- and medium-sized blood vessels of the brain makes these blood vessels fragile and prone to bleeding. Which is the primary cause of intracerebral hemorrhage in older adults.

Question 5

Arteriovenous Malformations

Answer 5

is associated with secondary intracerebral hemorrhage. Is an abnormal tangle of blood vessels arteries and veins in the brain that lacks capillary bed which .leads to dilation of the arteries and veins and eventual rupture. Most common in young people.

Question 6

Intracranial (Cerebral) Aneurysm

Answer 6

is a dilation of the walls of a cerebral artery that develops as a result of weakness in the arterial wall. n aneurysm may be due to atherosclerosis, a congenital (at birth) defect of the vessel wall; hypertensive vascular disease, head trauma; or advancing age.

Question 7

Subarachnoid Hemorrhage

Answer 7

hemorrhage into the subarachnoid space may occur as a result of an AVM, intracranial aneurysm, trauma, or hypertension. Many of the same motor, sensory, cranial nerve, cognitive, and other functions that are disrupted after ischemic stroke are also altered after a hemorrhagic stroke. Symptoms that may be observed more frequently in patients with acute intracerebral hemorrhage than ischemic stroke are nausea or vomiting, an early sudden change in level of consciousness, and possibly seizures.

Question 8

Immediate complications of a hemorrhagic stroke include ______ , ____ and _____ of the area of injury.

Answer 8

cerebral hypoxia, decreased ceberal blood flow, extension

Administering supplemental oxygen and maintaining the hemoglobin and hematocrit at acceptable levels will assist in maintaining tissue oxygenation.

Question 9

What are some commponets of components of care after a hemorrhagic stroke?

Answer 9

Stabllizing blood pressure, cardiac output, and integrity of cerebral blood vessels. Adequate hydration (IV fluids) must be ensured to reduce blood viscosity and improve cerebral blood flow. Extremes of hypertension or hypotension need to be avoided to prevent changes in cerebral blood flow and the potential for extending the area of injury. Observing for seizure activity and initiating appropriate treatment to avoid furhter changes in blood flow.

Question 10

Vasospasm

Answer 10

narrowing of the lumen of the involved cranial blood vessel is a serious complication of subarachnoid hemorrhage. It is associated with increasing amounts of blood in the subarachnoid cisterns and cerebral fissures,

Question 11

Increased Intracranial Pressure

Answer 11

An increase in ICP can occur after either an ischemic or a hemorrhagic stroke but almost always follows a subarachnoid hemorrhage sually because of disturbed circulation of CSF caused by blood in the basal cisterns. Leading factors for ICP are cerebral edema, herniation, hydrocephalus, or vasospasm

Question 12

Mannitol

Answer 12

To decrease cerebral edema with patients with increased intracranial pressure ICP. Mannitol pulls water out of the brain tissue by osmosis and reduces total body water through diuresis.

Long term use can cause dehydration and unequal electrolyte balance.

Question 13

Hypertension

Answer 13

is the most common cause of intracerebral hemorrhage. Guidelines for management of intracerebral hemorrhage recommend early blood pressure lowering if the systolic blood pressure is between 150 and 220 mm Hg to a goal systolic of 140 mm Hg. If systolic blood pressure is above 220 mm Hg, IV continuous infusions of antihypertensives may be prescribed.

Question 14

What are the goals of medical treatment for hemorrhagic stroke?

Answer 14

to allow the brain to recover from the initial insult (bleeding), to prevent or minimize the risk of rebleeding, and to prevent or treat complications.

• Bed rest with sedation
• Vasospasm, and surgical or medical treatment to prevent rebleeding

Question 15

Phenytoin (Dilantin)

Answer 15

To prevent seizures. Seizures place patients at risk for elevated bloof pressure and injury and should be prevented.

Question 16

Nicardipine (cardene)

Answer 16

To decrease systemic hypertension. Elevated cloos pressure puts patients at risk for hematoma (bleeding outside of vessel) enlargement.