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,
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.
—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
also known as anintracranial aneurysm, is a dilation of thewalls of a cerebral artery that develops as a
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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.