BRIEF DESCRIPTION OF THE DISEASE Hemorrhagic Stroke A hemorrhagic stroke happens when a blood vessel in the brain burst.

This may happen if the blood vessel wall is weak, or sometimes when a blood clot gets stuck in blood vessels. Blood then flows out of the vessel and into brain tissue. This leaking blood damages brain tissue. Damages to an area of the brain affects the body functions controlled by that area. Types:

Intracerebral hemorrhage. In this type of stroke, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging cells

Subarachnoid hemorrhage. In this type of stroke, bleeding starts in an artery on or near the

surface of the brain and spills into the space between the surface of your brain and your skull. This bleeding is often signaled by a sudden, severe "thunderclap" headache.

Intracranial (cerebral) Aneurysm. It is the dilation of the walls of a cerebral artery that develops as a result of weakness in the arterial wall. An aneurysm may be due to atherosclerosis, which result in the defect in the vessel wall with subsequent weakness of the wall; a congenital defect of vessel wall; hypertensive vascular disease; head trauma; or advancing age.

Arteriovenous Malformations. It is caused by abnormality in embryonal development that leads to a tangle of arteries and veins in the brain that lacks a capillary membrane. The absence of a capillary leads to dilation of the arteries and veins and eventual rupture. Risk Factors

Advanced age ( 55 years above) Hypertension (up to 60% of cases) Previous history of stroke Alcohol and illicit drug use, such as cocaine and other sympathomimetic drugs Atrial fibrillation Diabetes Family history of stroke High cholesterol Physical inactivity Black race Overweight or obese

Causes of hemorrhagic stroke:

Cerebral amyloidosis (affects people who are elderly and may cause up to 10% of intracerebral hemorrhages) Coagulopathies (eg, due to underlying systemic disorders such as bleeding diathesis or liver disease) Anticoagulant therapy Thrombolytic therapy for acute myocardial infarction (MI) and acute ischemic stroke (can cause iatrogenic hemorrhagic transformation) Arteriovenous malformation Intracranial aneurysm Vasculitis Intracranial neoplasm

Symptoms

Change in alertness (including sleepiness, unconsciousness, and coma) Headache Changes in hearing Changes in taste Changes that affect touch and the ability to feel pain, pressure, or different temperatures Clumsiness Confusion or loss of memory Difficulty swallowing Difficulty writing or reading Dizziness/nausea or abnormal feeling of movement (vertigo) Lack of control over the bladder or bowels Loss of balance Loss of coordination Muscle weakness in the face, arm, or leg (usually just on one side) Numbness or tingling on one side of the body Personality, mood, or emotional changes Problems with eyesight, including decreased vision, double vision, or total loss of vision Trouble speaking or understanding others who are speaking Trouble walking

Exams and Tests

Angiogram of the head can show which blood vessel is blocked or bleeding Carotid duplex(ultrasound) can show if the carotid arteries in your neck have narrowed CT scan of the brain is often done soon after symptoms of a stroke begin. An MRI scan of the brain may be done instead or afterwards Echocardiogram may be done if the stroke could have been caused by a blood clot from the heart Magnetic resonance angiography (MRA) or CT angiography may be done to check for abnormal blood vessels in the brain

Other tests include:

Lab tests will include: o Bleeding time o Blood cholesterol and sugar o Blood clotting tests (prothrombin time or partial thromboplastin time) o Complete blood count (CBC) Electrocardiogram (ECG) and heart rhythm monitoring -- to show whether an irregular heartbeat (such asatrial fibrillation) caused the stroke

Medical Treatment -Clot-busting drugs (thrombolytic therapy) may be used if the stroke is caused by a blood clot.

For these drugs to work, a person must be seen and treatment must begin within 3 hours of when the symptoms first started. A CT scan must be done to see whether the stroke is from a clot or from bleeding. If the stroke is caused by bleeding instead of clotting, clot-busting drugs (thrombolytics) can cause more bleeding.

-Other treatments depend on the cause of the stroke:

Blood thinners such as heparin or warfarin (Coumadin) may be used to treat strokes due to blood clots. Aspirin or clopidogrel (Plavix) may also be used. Other medicine may be needed to control symptoms such as high blood pressure.

Surgical treatment -Craniotomy -Craniectomy Nursing interventionss 1. Optimizing Cerebral Tissue Perfusion. The patient is closely monitored for neurologic deterioration resulting from recurrent bleeding, increasing ICP or vasospasm & respiratory status is monitored. 2. Implementing Aneurysm Precaution. Patients head is elevated 15-30 degrees to promote venous drainage and decrease ICP. 3. Relieving Sensory Deprivation and Anxiety. 4. Monitoring and Managing Potential Complications. CRANIECTOMY Craniectomy is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury and stroke. Description Before surgery, the hair on part of the scalp is shaved, and the area is cleaned. The doctor makes a surgical cut through the scalp. The location of this cut depends on where the problem in the brain is located. The surgeon creates a hole in the skull and removes a piece, called a bone flap. If possible, the surgeon will make a smaller hole and insert a tube with a light and camera on the end. This is called an endoscope. The surgery will be done with tools placed through the endoscope. MRI or CT can help guide the doctor to the proper place in the brain. INDICATIONS:

Brain tumor Bleeding (hemorrhage) in the brain Blood clot (hematomas) in the brain Weaknesses in blood vessels Abnormal blood vessels in the brain (arteriovenous malformations; AVM) Damage to tissues covering the brain (dura) Infections in the brain (brain abscesses) Severe nerve or face pain (such as trigeminal neuralgia or tic douloureux) Skull fracture Pressure in the brain after an injury or stroke Epilepsy Certain brain diseases (such as Parkinsons disease) that may be helped with an implanted electronic device

After the Procedure -Closely monitoring -The head of bed will be kept - Medicines will be given to relieve pain.