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haemorrhagic stroke

haemorrhagic stroke

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Published by lengkong
Raising awareness of

hemorrhagic

42 Nursing made Incredibly Easy! July/August 2009

www.NursingMadeIncrediblyEasy.com

stroke
The third leading cause of death in the United States, nearly 800,000 Americans experience a stroke each year. Up to 30% of stroke patients become permanently disabled, with 20% requiring institutional care 4 months after the event. We fill you in on what you need to know about hemorrhagic stroke—the most fatal type.
By Kelly A. Taft, RN, BSN • Nurse Practitioner
Raising awareness of

hemorrhagic

42 Nursing made Incredibly Easy! July/August 2009

www.NursingMadeIncrediblyEasy.com

stroke
The third leading cause of death in the United States, nearly 800,000 Americans experience a stroke each year. Up to 30% of stroke patients become permanently disabled, with 20% requiring institutional care 4 months after the event. We fill you in on what you need to know about hemorrhagic stroke—the most fatal type.
By Kelly A. Taft, RN, BSN • Nurse Practitioner

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Published by: lengkong on Jan 16, 2010
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 42Nursing made Incredibly Easy!
July/August 2009 www.NursingMadeIncrediblyEasy.com
Raising awareness of 
hemorrhagic
 
Stroke is an acute, focal neurologic deficitcaused by a vascular disorder that injures brain tissue. There are two main types: is-chemic stroke, caused by an interruption of blood flow in a cerebral vessel, and hemor-rhagic stroke, caused by a rupture of a cere- bral blood vessel. Although hemorrhagicstroke accounts for the minority of cases,it’s the most frequently fatal stroke, withspontaneous hemorrhage into the brain.In this article, I’ll discuss hemorrhagicstroke—the most common etiology for per-sons ages 18 to 45.
Understanding the causes
Accounting for 41% of hemorrhagic strokecases,
intracranial hemorrhage
is bleedingdirectly into the brain matter, usually occur-ring at bifurcations of major arteries at the base of the brain (the cerebral lobes, basalganglia, thalamus, brainstem, and cerebel-lum) as a result of hypertension, cerebralatherosclerosis, brain tumors, or the use ofmedication such as anticoagulants, amphet-amines, or illicit drugs.
Subarachnoid hem-orrhage
—bleeding surrounding the braintissue in the subarachnoid space generallyfrom an arteriovenous malformation(AVM), cerebral aneurysm (most commonlyat the circle of Willis), hypertension, ortrauma—accounts for 17% (see
Picturing twotypes of hemorrhage
). Even with advances indiagnostic testing, 20% ofstrokes inyounger persons continue to be of un-known etiology.Before discussing the pathophysiology ofhemorrhagic stroke, it’s important to under-stand the pathophysiology of its commoncauses: cerebral aneurysm, AVM, and hyper-tensive hemorrhage. Causes of hemorrhagicstroke not included in this discussion aretrauma, chronic cocaine and amphetamineuse, vasculitis, blood coagulation disorders,and cerebral tumors leading to erosion ofsurrounding vessels.A
cerebral aneurysm,
also known as anintracranial aneurysm, is a dilation of thewalls of a cerebral artery that develops as a
www.NursingMadeIncrediblyEasy.com July/August 2009
Nursing made Incredibly Easy!43
2.1
 ANCCCONTACT HOURS
stroke 
The third leading cause of death in the United States, nearly 800,000Americans experience a stroke each year. Up to 30% of stroke patients becomepermanently disabled, with 20% requiring institutional care 4 months after theevent. We fill you in on what you need to know about hemorrhagic stroke—themost fatal type.
By Kelly A. Taft, RN, BSN • Nurse Practitioner Student • University of Michigan—Flint • Grand Blanc, Mich.
The author has disclosed that she has no significant relationships with or financial interest in any commercial companies that pertain to this educational activity.
 
result of weakness in the arterial wall. Theprobability of rupture increases with the sizeof theaneurysm. An aneurysm may becaused by atherosclerosis, a congenital defectof the vessel wall, hypertensive vascular dis-ease, or head trauma. The most commonlyaffected cerebral arteries are the internalcarotid, anterior cerebral, anterior communi-cating, posterior communicating, posteriorcerebral, and middle cerebral arteries (see
Picturing a cerebral aneurysm
).An
 AVM 
is a complex tangle of abnormalarteries and veins that lacks a capillary bedand is linked by one or more fistulas. Bloodis shunted from the high pressure arterialsystem to the low pressure venous systemwithout buffering at the capillary level. Thedraining venous channels are exposed tohigh levels of pressure, predisposing them torupture and hemorrhage. A common causeof hemorrhagic stroke in young people, anAVM is considered to be a congenital abnor-mality.A
hypertensive hemorrhage
can occur inthe territory of penetrator arteries that branch off major intracerebral arteries. Thepenetrator vessels in patients with chronichypertension develop intimal hyperplasiawithin the vessel wall. This can cause necro-sis, which leads to breaks in the vessel walland, ultimately, hemorrhage. Hypertensioncan be treated appropriately to reduce the
 44Nursing made Incredibly Easy!
July/August 2009 www.NursingMadeIncrediblyEasy.com
Circleof Willis
 Anteriorcommunicatingartery AnteriorcerebralarteryMiddlecerebralarteryPosteriorcommunicatingarteryPosteriorcerebralartery AneurysmBasilarartery
Picturing a cerebral aneurysm
Cerebralaneurysms aregenerallyasymptomaticuntil theyrupture.Look out!
How it happens
Prolonged hemodynamic stress and localarterial degeneration at vessel bifurcationsare believed to be major contributingfactors in the development and eventualrupture of cerebral aneurysms.

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