🩸 Stroke – Hemorrhagic

📌 Definition

A hemorrhagic stroke occurs when a ruptured blood vessel causes bleeding into the brain tissue (intracerebral hemorrhage) or subarachnoid space, leading to increased intracranial pressure (ICP), brain tissue damage, and impaired cerebral function.

🧠 Anatomy & Physiology: Brain

  • Brain requires constant oxygen and glucose
  • Enclosed in rigid skull—bleeding increases intracranial pressure
  • Types of hemorrhagic stroke:
    • Intracerebral hemorrhage: bleeding within brain tissue
    • Subarachnoid hemorrhage: bleeding into the space around the brain
  • Affected brain regions may control motor, sensory, speech, cognition, or vital signs depending on bleed location

⚠️ Etiology: Causes & Risk Factors

  • Uncontrolled hypertension (most common)
  • Ruptured cerebral aneurysm
  • Arteriovenous malformation (AVM)
  • Trauma
  • Bleeding disorders (e.g., hemophilia)
  • Anticoagulant overuse
  • Drug use (cocaine, amphetamines)

🩺 Symptomatology

  • Sudden, severe headache (“worst headache of my life”)
  • Loss of consciousness or altered mental status
  • Vomiting without nausea
  • Seizures
  • Sudden neurologic deficits (e.g., weakness, slurred speech, vision loss)
  • Signs of increased ICP:
    • Bradycardia, hypertension, irregular respirations (Cushing’s triad)
    • Pupillary changes
    • Posturing

🔁 Pathophysiology (Simplified)

  1. Rupture of cerebral vessel → bleeding into brain
  2. Blood accumulates → increases ICP
  3. Compression of brain tissue → impaired oxygenation
  4. Brain herniation may occur if ICP not controlled
  5. Neurologic function declines rapidly

🧪 Medical Management

🔬 Labs & Diagnostics

  • Non-contrast CT scan: first-line to identify bleeding
  • MRI/MRA: better visualization of small bleeds or aneurysms
  • Coagulation profile (PT/INR, aPTT): rule out coagulopathies

💊 Medications

  • Antihypertensives: Labetalol, Nicardipine (lower BP cautiously)
  • Osmotic diuretics: Mannitol (reduce ICP)
  • Anticonvulsants: Phenytoin, Levetiracetam (prevent seizures)

🛠️ Treatment Options

  • Surgical interventions:
    • Craniotomy or hematoma evacuation
    • Clipping/coiling of aneurysms
    • Ventriculostomy for CSF drainage and ICP monitoring
  • Supportive ICU care (ICP, BP, airway, perfusion management)

🧑‍⚕️ Nursing Management: 5 Key Interventions

  1. Maintain airway & oxygenation—elevate HOB, suction, intubate if needed
  2. Monitor for increased ICP (GCS, pupils, vitals)
  3. Control blood pressure within prescribed limits
  4. Prevent complications (aspiration, infection, contractures)
  5. Educate/support family about prognosis and rehab planning

🩹 Priority Nursing Diagnoses

  • Ineffective cerebral tissue perfusion r/t bleeding & increased ICP
  • Decreased intracranial adaptive capacity
  • Risk for aspiration r/t impaired consciousness or swallowing
  • Acute confusion r/t cerebral dysfunction
  • Impaired physical mobility r/t hemiparesis or weakness

📉 Prognosis

  • Generally worse than ischemic stroke
  • High risk of death or severe disability, especially in massive bleeds
  • Early intervention improves survival chances
  • Recovery depends on bleed size, location, and speed of management