Study Notes on Hemorrhagic Stroke

Accounts for approximately 80% of hemorrhagic strokes.
Caused chiefly by uncontrolled hypertension.
Example situation: Patients with blood pressures in the 170s or 180s are at severe risk for vessel rupture.

Results from ruptured intracranial aneurysms.
Important note: The priority is patient care rather than identifying stroke type (the focus shifts to managing patient condition).

Associated with arteriovenous malformations (AVMs).
Additional causes include:
- Trauma
- Intracranial neoplasms
- Certain medications, especially anticoagulants
- Illicit drugs (cocaine and amphetamines)
Mortality rate after intracranial hemorrhage can be as high as 50%.
Hemorrhagic strokes have higher mortality rates compared to ischemic strokes.
Survivors tend to have more severe deficits and longer recovery compared to ischemic stroke survivors.

Definition: A dilation of the walls of a cerebral artery due to weakness in the arterial wall.
Possible causes include:
- Atherosclerosis (plaque buildup leading to vessel weakness)
- Congenital defects
- Hypertensive vascular disease
- Head trauma
- Advancing age
Aneurysms can be either torn or burst.

Caused by abnormal development during embryonic growth leading to tangles of arteries and veins lacking a capillary bed.
Visual metaphor: akin to a knot in hair that becomes challenging to untangle.
AVMs are the most common cause of hemorrhagic strokes in young individuals.

A mnemonic to remember symptoms associated with hemorrhagic stroke (details not specified).
Common manifestations:
- Severe headache: Most reported by conscious patients.
- Neurological deficits similar to ischemic strokes.
- Nausea and vomiting: Increased intracranial pressure leads to these symptoms.
- Changes in consciousness: May range from confusion to coma.
- Seizures: Possible occurrence in acute intracranial hemorrhage.

First sign of fever requires interventions:
- Administer antipyretics (e.g., Tylenol).
- Physical cooling strategies: cold washcloths, ice packs in areas like armpits or groin.
- Considering cooling blankets if affected by hypothalamic regulation due to bleeding.

Any patient suspected of a stroke should undergo:
- CT scan or MRI to determine stroke type, size, and location.
- Advocacy: Ensure imaging is done before starting anticoagulation therapies (e.g., heparin).
CT scans are preferred for their rapid detection of bleeding.
A cerebral angiograph or CT angiogram confirms cases of aneurysms or AVMs.
- Visuals include images of CT scans showing bleeding and angiograms confirming aneurysms.

Focus on managing hypertension:
- Maintain a low-salt diet, consume fruits and vegetables.
- Implement lifestyle changes: reduce alcohol intake, avoid smoking, and take precautions against head injuries (e.g., wearing helmets in contact sports).
Encourage participation in stroke screenings and early treatment in case of symptoms.

Administer oxygen (via cannula/mask) for hypoxia.
Monitor and maintain hemoglobin and hematocrit levels; possible blood transfusions and administration of blood products (e.g., red blood cells, fresh frozen plasma).
Administer IV fluids for hydration and improved blood flow.
- Maintain electrolyte balance, especially for potassium and sodium.

Monitor and assist patients for potential surgical interventions if rebleeding occurs.

Continuous monitoring of blood pressure; intervention needed for readings above specified thresholds (e.g., >140s or facility-specific protocols).
Medications to consider for hypertension:
- Nicardipine (calcium channel blocker): causes systemic vasodilation.
- Other options: Labetalol, Hydralazine.
Monitor patient hemodynamic status and potential drops in blood pressure due to medications.
Administer stool softeners to counteract constipation risk associated with medication and prevent straining.