INTRODUCTION

A Cerebrovascular disorder or CVA is damage to part of the brain when its blood
supply is suddenly reduced or stopped. A CVA may also be called stroke. The part of the
brain deprived of blood dies and can no longer function. Blood is prevented from
reaching brain tissue when a blood vessel leading to the brain becomes blocked
(ischemic) or bursts (hemorrhagic). The symptoms of a stroke differ, depending on the
part of the brain affected and the extent of the damage. Symptoms following a stroke
come on suddenly and may include: weakness, numbness, or tingling in the face, arm, or
leg, especially on one side of the body trouble walking, dizziness, loss of balance, or
coordination inability to speak or difficulty speaking or understanding, trouble seeing
with one or both eyes, or double vision, confusion or personality changes, difficulty with
muscle movements, such as swallowing, moving arms and legs, loss of bowel and
bladder control, severe headache with no known cause, and loss of consciousness.
Ischemic stroke, cerebrovascular accident (CVA), or brain attack is a sudden
loss of the blood supply to a part of the brain. Ischemic strokes are subdivided into five
different types based on the cause:

large artery thrombosis strokes (20%), small

penetrating artery thrombotic strokes (25%), cardiogenic embolic strokes (20%),

cryptogenic strokes (30%) and other (5%).
Hemorrhagic strokes account for 15% to 20% of cerebrovascular disorders and
are primarily caused by intracranial or subarachnoid hemorrhage. Hemorrhagic strokes
are caused by bleeding in the brain tissue,the ventricles, or the subarachnoid space.
Primary intracerebral hemorrhage from a spontaneous rupture of small vessels accounts

for approximately 80% of hemorrhagic strokes and is caused chiefly by uncontrolled

hypertension. Subarachnoid hemorrhage results from ruptured intracranial aneurysm in
about half the cases.
Many studies were conducted regarding cerebrovascular accidents tackling
different aspects of cerebrovascular accident such as; the cause, precipitating factors,
predisposing factor, and its prevalence throughout the world as one of the top ten leading
causes of morbidity.
The severity associated with cerebrovascular accident can best be demonstrated
by the following facts: CVA is the leading cause of adult disability in the world.

NURSING HEALTH HISTORY

A. INITIAL DATA
Hospital
Chief Complaint
Date Of Admission
Time Of Admission
Mode Of Admission
Ward

Ospital Ng Maynila Medical Center

Left sided weakness with slurry speech
June 17,2011
11:00 am
Wheelchair
From Emergency Room, she was
transffered to Medicine Ward last june 17,

General Appearance

2011
Upon admission to the ER, the patient
verbalize of sudden onset of left sided

Admitting Diagnosis

weakness upon waking up.

To Consider Cerebrovascular Accident
(CVA) Hemmorhagic

B. DEMOGRAPHIC DATA
Patient Name
Address
Age
Date of Birth
Sex
Occupation
Nationality
Marital Status
Religion
Usual Source Of Health Care

Mr. DA
Pasay City
45 years old
-Male
House Keeping Supervisor
Filipino
Single
Seventh Adventist
--

C. CHIEF COMPLAINT
Client was brought in to hospital after experiening left-sided weakness asssociated
with slurring of speech.
3

D. HISTORY OF PRESENT ILLNESS

5 years prior to admission (2005)

3 years prior to admission (2007)

5 months prior to admission
1 hour prior to admission

The patient had sudden onset of left-sided

weakness upon waking up, causing him to
fall off the sofa. Weakness was associated
with slurring of speech. No loss of
consciousness, no fever, and no vomiting

Few minutes prior to admission

was noted.
On the way to the hospital, patient had an
episode of vomiting, non-projectile, about
50 cc in volume.

E. PAST MEDICAL HISTORY

Medical History
Surgical History
Allergies

The client did not undergone any surgery.

The client verbalized that he has no
allergies on medications and drugs.She also
added that she has no allergies to any kinds

Injuries/accidents

of foods.
He did not experienced any major
accidents.But had minor injuries because of
minor accidents.

F. FAMILY HISTORY
Family Medical History

G. SOCIAL HISTORY
Alcohol Use

The client drink occassionally as stated by

Drug Use

his brother.
Patient verbalized that he is not taking any

Tobacco use

prohibited drugs or medications.

Patient verbalized that he is smoking
sometimes.

I. HEALTH MAINTENANCE ACTIVITIES

Sleep

According to the patients daughter, her

mother usually sleeps from 10pm to 4pm or
5-6 hours of sleep per day because she

Diet

prepared early the foods they will sell.

According to patients daughter and
husband, the client likes to eat salty and
fatty foods. The client is also fond of eating

Exercise

"isaw and adidas".

The client exercise is walking every
morning as she goes to the matket. The
informant said that she assist her rmother
when going to the market whcih is their
5

form of exercise. As of hospitalization,

clients daughter assisted her mother on her
daily exercise like a simple rotation and
Elimination

flexion of extremities.
According to clients daughter, the client
usually has one bowel movement every
morning before she was hospitalized. As
she was hospitalized her bowel movement
is every other day and she has an
indwelling catheter attached to urine bag.

PHYSICAL EXAMINATION
Physical examination follows a methodical head to toe format in the
Cephalocaudal assessment. This is done systematically using the techniques of
inspection, palpation, percussion and auscultation with the use of materials such as the
penlight, thermometer, tape measure and stethoscope and also the senses. During the
procedure, the researchers made every effort to recognize and respect the patients
feelings as well as to provide comfort measures and follow appropriate safety
precautions.

General Survey

The client is a 45 year-old male. Upon assessment on June 30, 2011, the client is
weak in appearance. Appears and behaves to be as her apparent age. He has a fair skin
complexion and body built.
Interaction and answering of questions was done with the client and with the help
of his brothers, who were staying at the hospital to look after him.
The client has a temperature of 36.8oC, pulse rate of 82 bpm, and respiratory
rate of 24bpm and blood pressure of 150/90 mmHg. Client is afebrile and with some
alterations in the clients BP and respiratory rate.
Area of
Assessment

Type of
Assessment
Used

Results

Analysis

Head

- Inspection

The clients head is proportionate

The client has a normal

to the body size, There were no

head size and shape. Her

tenderness in the scalp. There

hair is consistently

were no presence of nodules, and

distributed and has a

infestation. Her hair is evenly

normal color. The face is

distributed and the strands are

asymmetrical and has

thin and brittle. The color of her

difficulty showing her

hair is a mixture of white and

expressions. Pain is also

black. Her head is round and

manifested on her facial

symmetrical its consistency is

expression.

hard. She cant control her head

and the shape of his face is round
and asymmetrical and its
consistency is soft. She feels pain
on the left side of her head.
Eyes

- Inspection

The condition of her eyes is

Her eyes appeared normal

straight normal; the eye brows

physically. She doesnt

are evenly distributed. Eyelids

have any eye defects and

have effectively closure. The

but has difficulty on

blink response is bilateral, eye

visualization.

balls are symmetrical, the

palpebral conjunctiva is pink and
the sclera is white. The corneal
sensitivity reflex is present
cornea is transparent, the color of
his eyes are brown, the shape are
equal, it is uniform in color.
Pupils are equal in size. Pupils
are equally round and reactive to
light and accommodation. She
8

experiences blurred vision upon

assessment.
The ears have a normal
Ears

- Inspection

The color of the ear is of normal

appearance. It doesnt

and Palpation

racial tone which is brown, it is

have any abnormal

symmetrical. The alignment of

discharges and functioning

the pinna is symmetrical. The

normally without any

pinnas are elastic and recoil when hearing aids.

folded. The auditory canal
contains some cerumen, the color
is brown and there is an absent of
discharges.
The nose has a normal
Nose

- Inspection

The color of the clients nose is

color, shape and

and Palpation

of racial tone which is brown.

consistency. She has a

Her septum is in the midline. The

normal breathing airway

mucosa is pink, nostrils are both

through her nose with

patent, nasal flaring is absent.

some difficulty.

There is an NGT in his left

nostrils.
The mouth is functioning
Mouth

- Inspection

The lips is symmetrical and pink,

normally. The client had

the consistency is smooth, buccal

difficulty in performing

mucosa is pink, the gum is pink,

oral hygienic care for her

the tongue is in the midline, the

condition.

color is pink and it is smooth.

The tongue movements are not
that smooth. Its texture is rough.
The color of the hard and soft
palate is pink. And it is intact.
There is presence of mucous.
9

Uvula is in the midline, gag

reflex is absent. The teeth are
incomplete.

Skin is in normal finding.

Elasticity is loss due to

Skin

- Inspection

The clients skin is of normal

and Palpation

racial tone which is brown. It is

aging.

dry and smooth. The skin turgor

is wrinkled and loss of elasticity.
The body hair is evenly
distributed. She doesnt have any
edema but she has a skin lesion

The neck movements are

on her hand.

not coordinated and with

signs of pain and

Neck

- Inspection

The neck has involuntary

discomfort which are due

and Palpation

movement and with resistance,

to neuromuscular

The trachea is in the midline,

impairment.

thyroid is in the midline and it is

smooth. Maxillary lymph nodes

The chest and lungs are

are palpable.

normal in appearance and

functioning. Wheezing is

Chest and
Lungs

Inspection,

The color of the chest is of

present due to the patients

palpation and

normal racial tone which is

cough.

Auscultation

brown. There is absence of

intercostals retraction, chest wall
are symmetrical, and the chest
expansion is symmetrical.
Wheezing sound is heard upon
auscultation.

The abdomen of the client

is normal in appearance
and functioning.

Abdomen

Inspection,

Skin is of normal racial tone

Palpation

which is brown, the contour is

10

and

flat. Peristalsis is non-visible.

Auscultation

The color of her stool is brown, it

is semi formed.When palpated
she doesnt have any tenderness
and when light palpation is done
muscle guarding is absent. The

The client has complete

liver is not palpable.

upper extremities with

normal findings. Lesions

Upper
extermities

- Inspection

The client cannot resist force

are present. Right side

and Palpation

when asked to resist. She has a

functioning is altered due

skin lesion in her right hand and

to neuromuscular

some scars on her left hand. The

impairment.

peripheral pulses are equal.

Lymph nodes are not palpable.
The IV site is in her left arm.
Lack of sensation is present on
her right arm. She has edema on

The client has complete

both hands and graded as 2+.

lower extremities. They

have normal skin color,

Lower
Extremities

- Inspection

The client cannot resist force

texture, moisture without

and Palpation

when asked to resist. She doesnt

any edema, lesions and

have any deformity. The

varicosities. Functioning is

peripheral pulses are equal.

altered on the right side

Lympnodes are non-palpable. No

due to neuromuscular

lesions are observed and the

impairment.

client is still unable to ambulate.

Bth feet have edma present and
graded as 2+.

GORDONS TYPOLOGY
11

HEALTH

BEFORE

AFTER

INTERPRETATION

PATTERN
Health

HOSPITALIZATION HOSPITALIZATION
Upon asking, the
The patient and her
Health was given

Perception/

patient nodded that she

family had perceived

importance after

didnt follow doctors

the importance of

realization of clients

prescription and

proper caring for her

status upon

advices regarding her

health since she was

hospitalization. She

health status.

admitted.

understands and

Health
Management
Pattern

develop awareness on
her health condition
and needs to be
teaches more about her
Nutritional

The patient usually eat

Since hospitalization,

health condition.
There is a change in

Metabolic

foods that is high in

the patient is on soft

eating pattern of the

Pattern

cholesterol but since

diet and IVF of PNSS

patient; she is

she was diagnosed of

for rehydration and

restricted to take salty

being hypertensive she

nutritional

and fatty foods and she

gradually avoided this

requirements.

need to have a good

kind of foods.

eating pattern and a

choice of a good food
that will sustain her

Elimination

The client have a good

Since the patient was

nutritional needs.
The client has a

Pattern

elimination pattern in

hospitalized, she

catheter attached to
12

terms of her stool and

experience difficulty in

urine bag, she tends to

urine.

fecal elimination. She

urinate more often

defecate every other

during hospitalization

day. She has an

than before , due to the

indwelling catheter

medications given to

attach to the urine bag.

her. But her metabolic

process undergoes
changes because of
decrease activity due

Activity-

Upon asking the patiet

The patinet nodded yes

to her condition.
The patient

Exercise

if she has any activity,

upon asking if she was

experiences huge

Pattern

the patient nodded yes

assisted by her

changes on her activity

and sign walking when

daughter in doing

and exercise for she

Sleep-Rest
Pattern

asked what activity and simple exercise like

was now depending on

exrcise she is doing.

flexion and extension

her daughter. Thus,

This has connection

of her extremeties.

significant others play

with her work as a

a great role on helping

eatery vendor.

the patient cope up on

The patient lack

Since the patient was

her health condition.

The patient did not

enough sleep and rest.

hospitalized, she has

sustain enough sleep

It is because of her

increase time to sleep

and rest periods

work that she needs to

and take a rest to

because of her work.

13

sleep late at night and

sustain her needs.

Whe she was

woke up early. When

hospitalized, she got

asked what time she

more time to sleep and

ususally sleeps, the

rest.

patient show her both

hands which signifies
10pm. When asked on
what time she usually
Cognitive

woke up, she sign 4am.

The patient is aware on

She realizes the

The patient is aware

Perceptual

her health condition.

importance of her

on her health condition

Pattern

Thus she know very

health condition when

and didnt follow

well what might

she was hospitalized.

doctors advice and

happen but because her

With her family,

prescription. Thus, her

family is unable to

disease progresses,

provide financial

which when she seek

assistance to provide

advice from health

enough care, she has

care professionals.

no choice but to ignore

Therefore, she realizes

this.

the importance of
maintaining health

RoleRelationship

The client said that the

Since the client was

lifestyle.
She had a good

relationship of their

admitted in the

supportive family

14

Pattern

family members are

hospital, she is

which she needed on

good, sometimes she

dependent on her

her situation now. It is

was caring for her

daughter, husband and

also needed that her

daughters son.

sometimes to the other

family should adapt to

family members.The

changes in the role and

family became her

responsibilities of the

source of strenght

patient..

while recovering on
her disease.

Value- Belief
Pattern

The patient was a

Since the patient was

The clients values and

Roman Catholic and

admitted in hospital

beliefs become

she usually go to

she cant go to church

stronger after

church every Sunday.

thats why she said that

hospitalization and it

She also said that there

she was prayed before

influence how active a

are times when she

starting the day and

role is.

cant attend mass when

before sleeping.

she is feeling sick or

Sexuality/
Reproduction

weak.
The client said that
she was not sexually

Since the client was

The client was not

admitted to the

sexually active

15

Pattern

active because of her

hospital she was not

age.

sexually active

anymore.

because of her
Coping/Stres
s tolerance

The patient said that

condition.
Because of her

The patient eats

when she had a

condition right now

barbeque whenever

problem she doesnt

the patient can talk to

she feels stressed to

told it to anyone of

her daughter of what

compensate for such

the member of the

she feels for her

stressful moments

family instead as a

illness.

before

coping mechanism

hospitalization. But

she usually eats

during hospitalization

barbeque.

she always talk to her

daughter because of
her condition

REVIEW OF SYSTEMS

General

The client nodded, implying Oo when she was asked if

nahihirapan siyang gumalaw at magsalita dala ng kanyang
karamdaman.
The client gained weight and experienced weakness in the
right part of her body.
16

Skin

The client has edema on the hands and on both feet with a
grade of 2+.

Head, Eyes, Ears, Nose, Throat Head: The client nodded her head, implying Oo when she
(HEENT)

was asked if she was experiencing headache.

Eyes: The client nodded, implying Oo when she was asked
if she has blurring of vision and if her eyes are painful.
Ears: The client shook her head, implying Hindi when she
was asked if there is painful sensation in her ears. The
clients has a good hearing because she can respond to the
question upon interviewing but she cant speak normally.
She has a slurred speech because of her condition.
Nose: The client doesnt experienced colds but she usually
experienced itching in her nostril because of her NGT.
Throat: The client had cough.

Respiratory

The client nodded, implying Oo when she was asked if she

had cough.
Wheezing sound was heard upon auscultation.

Cardiovascular

The client nodded, implying Oo when she was asked if she

experiences chest pain.
The client has NGT because of her condition, she cant used

Gastrointestinal

her mouth to chew and has difficulty chewing and

17

Genitourinary

Musculoskeletal

swallowing.
The client has a foley catheter and have a normal urine
output and color as monitored in the urine bag.
The client shook her head, implying Hindi when she was
asked if her body joints are painful when her body is moved..
The client experiences weakness on her right part of the
body.
The client is sometimes not oriented on time but is able to

Neurologic

identify the person she is talking to and the place where she

Hematologic

is.
The client shook her head, implying Hindi when she was
asked if she experiencing any bleeding (nose, gums).

18

ANATOMY AND PHYSIOLOGY

Nervous System

The nervous system is the body's information gatherer, storage center and control system.
Its overall functions are to collect information about the body's external/internal states
and transfer this information to the brain (afferent system), to analyze this information,
and to send impulses out (efferent system) to initiate appropriate motor responses to meet
the body's needs.
The system is composed of specialized cells, termed nerve cells or neurons that
communicate with each other and with other cells in the body. A neuron has three parts:
1. the cell body, containing the nucleus
2. dendrites, hair-like structures surrounding the cell body, which conduct incoming
signals.
19

3. the axon (or nerve fiber), varying in length from a millimeter to a meter, which
conduct outgoing signals emitted by the neuron. Axons are encased in a fat-like
sheath, called myelin, which acts like an insulator and, along with the Nodes of
Ranvier, speeds impulse transmission.
Typically a given neuron is connected to many thousands of neurons. The specific point
of contact between the axon of one cell and a dendrite of another is called a synapse.
Messages passed to and from the brain take the form of electrical impulses, or action
potentials, produced by a chemical change that progresses along the axon. At the synapse,
the impulse causes the release of neurotransmitters (like acetylcholine or dopamine)
and this, in turn, drives the impulse to the next neuron. These impulses travel very fast
along these chain of neurons -- up to 250 miles per hour. This contrasts with other
systems, such as the endocrine system, which may take many hours to respond with
hormones.
The nerve cell bodies are generally located in groups. Within the brain and spinal cord,
the collections of neurons are called nuclei and constitute the gray matter, so-called
because of their color. Outside the brain and spinal cord the groups are called ganglia.
The remaining areas of the nervous system are tracts of axons, the white matter, so-called
because of white myelin sheath. Tracts carrying information of a specific type, such as
pain or vision, generally have specific names. .
Major Divisions of the Nervous System
The nerves of the body are organized into two major systems:

the central nervous system (CNS), consisting of of the brain and spinal cord,

the peripheral nervous system (PNS), the vast network of spinal and cranial
nerves linking the body to the brain and spinal cord. The PNS is subdivided into:
1. the autonomic nervous system (involuntary control of internal organs,
blood vessels, smooth and cardiac muscles), consisting of the sympathetic
NS and parasympathetic NS
2. the somatic nervous system (voluntary control of skin, bones, joints, and
skeletal muscle).

The two systems function together, with nerves from the periphery entering and
becoming part of the central nervous system, and vice versa.
20

Brain Structures

The brain, the body's "control central," is one of the largest of adult organs, consisting of
over 100 billion neurons and weighing about 3 pounds. It is typically divided into four
parts: the cerebrum, the cerebellum, the diencephalon (thalamus, hypothalamus,
sometimes classed as cerebral structures) and the brain stem (medulla oblongata, pons,
midbrain), which is an extension of the spinal cord.
Cerebrum
The largest division of the brain, the cerebrum, consists of two sides, the right and
left cerebral hemispheres, which are interconnected by the corpus callosum. The two
hemispheres are "twins," each with centers for receiving sensory (afferent) information
and for intiating motor (efferent) responses. The left side sends and receives information
to/from the right side of the body, and vice versa. Various intellectual functions are
concentrated in either the left or right hemispheres.
The hemispheres are covered by a thin layer of gray matter known as the cerebral
cortex. The interior portion consists of white matter, tracts, and nuclei (gray matter)
where synapses occur. Each hemisphere of the cerebral cortex is divided into four "lobes"
by various sulci and gyri: The sulci (or fissures) are the grooves and the gyri are the
"bumps" on the brain's surface.

21

The four lobes perform specific functions:

a) Frontal - controls fine movements (Betz cells)/ upper motor neuron) and smell.
Also, center for abstract thinking, judgment, and language (left hemisphere)
b) Parietal - coordinates afferent information dealing with pain, temperature, form,
shape, texture, pressure, and position. Some memory functions are also found here.
c) Temporal - handles dreams, memory, and emotions. Center for auditory function.
d) Occipital - governs vision
In addition to the four lobes, is the basal ganglia. The basal ganglia aggregates of
neurons (gray matter), constitute the extrapyramidal system. The extrapyramidal system
governs postural adjustment and gross voluntary movements, as opposed to fine
movements, controlled by the frontal lobe. The basal ganglia receive afferent input from
the cerebral cortex and thalamus. Their axons synapse in the brain stem and the spinal
cord.
Cerebellum
The cerebellum, the second largest brain structure, sits below the cerebrum. Like
the cerebrum, the cerebellum has an outer cortex of gray matter and two hemispheres. It
receives/relays information via the brain stem. The cerebellum performs 3 major
functions, all of which have to do with skeletal-muscle control:
Function summary:

Balance/ Equilibrium of the trunk

Muscle tension, spinal nerve reflexes, posture and balance of the limbs

Fine motor control, eye movement. (Incoming information is transferred from the
cerebral cortex via the pons. Outgoing information goes back to the cortex via the
thalamus.)
22

Cerebellar disease (abscess, hemorrhage, tumors, and trauma) results in ataxia (muscle
incoordination), tremors, and disturbances of gait and equilibrium. This can also interfere
with a person's ability to talk, eat, and perform other self care tasks. Paralysis does not
result from loss of cerebellar function.
Diencephalon
The diencephalon, located between the cerebrum and the midbrain, consists of several
important structures, two of which are the:

Thalamus: large, bilateral (right thalamus/left thalamus) egg-shaped mass of gray

matter serving as the main synaptic relay center. Receives/relays sensory
information to/from the cerebral cortex, including pain/pleasure centers.

Hypothalamus: a collection of ganglia located below the thalamus and associated

with the pituitary gland. It has a variety of functions: senses changes in body
temperature; controls autonomic activities and hence regulates the sympathetic
and parasympathetic nervous systems; links to the endocrine system/controls the
pituitary gland; regulates appetite; functions as part of the arousal or alerting
mechanism; and links the mind (emotions) to the body -- sometimes,
unfortunately, to the degree of producing "psychosomatic disease."

Brain-Stem
The medulla oblongata, pons, and midbrain (mesencephalon or cerebral
peduncles) -- often referred to collectively as the brain stem -- control the most basic life
functions. Of these three, the medulla is the most important. In fact, so vital is the
medulla to survival that diseases or injuries affecting it often prove fatal. All functions of
the brain stem are associated with cranial nerves III-XII.
Function summary:

Breathing/respiration (pons, medulla)

Heart rate/ action (medulla)

Blood pressure (vasoconstriction)/ blood vessel diameter (medulla)

Reflex centers for pupillary reflexes and eye movements (midbrain, pons); and for
vomiting, coughing, sneezing, swallowing, and hiccupping (medulla).

23

Blood supply
An intricate arterial structure supplies the brain with oxygen-rich blood. At the brain
stem, two vertebral arteries, entering through the first cervical vertebrae, join to form the
basilar artery. The basilar artery along with two internal carotid arteries, entering through
holes at the base of the skull, interconnect at the Circle of Willis. From there, the anterior
and middle cerebral arteries arise; the posterior cerebral artery arises from the basilar
system.
Cranial Nerves
There are 12 pairs of cranial nerves. Some bring information from the sense
organs to the brain; some control muscles; others are connected to glands or internal
organs.
Cranial Nerves
I. Olfactory
II. Optic
III. Occulomotor
IV. Trochlear

Major Function
Smell
Vision
Eyelid and eyeball movement
Innervates superior oblique turns eye

V. Trigeminal
VI. Abducens
VII. Facial

downward and laterally

Chewing face & mouth touch & pain
Turns eye laterally
Controls most facial expressions secretion

VIII. Vestibulocochlear
IX. Glossopharyngeal
X. Vagus

of tears & saliva taste

Hearing equilibrium sensation
Taste senses carotid blood pressure
Senses aortic blood pressure slows heart

XI. Spinal Accessory

rate stimulates digestive organs taste

Controls trapezius & sternocleidomastoid,

XII. Hypoglossal

controls swallowing movements

Controls tongue movements

Pathophysiology
Precipitating Factors:
Hypertension
BP: 200/140 mmHg

Predisposing Factors:
Life style
(sedentary)
Age : 53 years
old
24
Diet :Salty and
fatty foods
-

Atherosclerosis

Formation of Plaque deposits

Thrombosis

Hypertension

Occlusion in major vessel

Vascular wall becomes

weakened and fragile

Rupture of the affected

blood vessel
CT Scan

Acute Intraparenchymal
hemorrahage

Sx:, headache,
Unconsciousness, visual
disturbances

Mass of blood forms and

grows
Cerebral Hemorrhage
Vasospasm of
tissue and arteries
Blood seeps into the
ventricles

Formation of small
and large clots

Sx: dizziness,
confusion,
headache

CEREBRAL HYPOPERFUSION

25

Impaired distribution of
oxygen and glucose

Tissue hypoxia and cellular

starvation
Lodges unto
other cerebral
arteries

Cerebral Ischemia

Initiation of ischemic
cascade

Anaerobic metabolism by
mitochondria

Generates large amounts

of lactic acid

Failure production of
adenosine triphosphatase

Metabolic Acidosis

Failure of energy dependent

process
(ion pumping)
Release of excitatory
neurotransmitter glutamate

Production of oxygen free

radicals and other reactive
oxygen species

Damage to the blood

vessel endothelium

Influx of calcium

Failure of
Activates enzymes that
mitochondria
digest cell proteins, lipids
and nuclear material
Brain sustains an irreversible
cerebral damage Further energy
depletion
Release of metalloprotrease
(zinc and calcium-dependent enzymes)
Break down of collagen, hyaluronic acid and
other elements of connective tissue
Lateral
hemisphere,
frontal, parietal
and temporal
lobes, basal
Middle
ganglia
Cerebral Artery

Structural integrity loss of brain

tissue and blood vessels

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Breakdown of the protective
Blood Brain
Barrier
Impaired
perfusion
and
function
Compression
of
tissue
Vascular
Congestion
Cerebral
edema

S/Sx:
Contralateral
hemiparesis,
unilateral
neglect, altered
consciousnes,
vision changes,
aphasia,
memory deficits,
headache, slurry
speech

Laboratory and Diagnostic Procedures

I. Computed Tomography (CT) Scan

27

Scan:
There is an acute hemorrhage measuring about 3.1 x 4.3 x 3.8 cm (volume of
about 26 cc) predominantly involving the right thalamucapsuloganglionic region with
perilesional edema and intraventricular dissection. There is an associated compressive
effect to the right lateral ventricle with leftward midline shift of about 0.4 cm. The left
lateral ventricle and temporal horns are dilated. There is likewise some effacement of the
underlying sulci.
Incidental note of mucous retention cyst in the right maxillary sinus.
Impression:
Acute hemorrhage predominantly involving the right thalamucapsuloganglionic
region with intraventricular dissection for the associated and other findings, please see
body of the report.

II. Hematology
Date: Nov. 26, 2010

Components

Result

Normal Values

Hemoglobin Count

13.5

12-14g/dl

Hematocrit

0.41

0.37-0.47
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WBC count

14.2

4.810.8 x 109

Segmenters

85

60-70%

Lymphocyte

15

30-40%

Eosinopril

1-3%

Monocyte

2-8%

Stab

2-6%

Basophil

0-1%

Platelets

363

130-400x 10 9

ANALYSIS:

Increased white blood cells indicate more disease-fighting cells in her body and
increased expected when body is fighting off an infection.

III. Urinalysis
Macroscopic
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Physical Characteristics
Color: yellow
Transparency: slightly turbid
Microscopic
Pus Cell: many
Red Cell : 1-4
Epithelial Cell: moderate
Mucus Thread: 0
Amorphous Urate: few
Chemical
Albumin: +
Sugar: Specific Gravity: 1.020
pH: 5

ANALYSIS:
All values profound to normal results. The color amber yellow is ideal and the slightly
turbid transparency is also a normal finding. The microscopic results suggest no
significant changes and alterations to its normal values.

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