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Intracranial Hemorrhage

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					                                  Intracranial Hemorrhage

WHERE?

1. Extradural space
2. Subdural space
3. Subarachnoid space
4. Into brain tissue/ventricles

S&S:

1. LOC decreaed d/t hemorrhage
2. Altered neuro signs
3. Brain herniation & death

NB:

Not always S&S immediately; depends on site and rate of bleed

Initailly may be no S&S

NB: Need to do do a FULL assessment!!!

                                   Types of Hemorrhage

1. EPIDURAL HEMORRHAGE:

  - least common
  - d/t skull fracture
  - dura strips away from skull; therefore INCREASED
    PRESSURE!!

S&S Epidural Hemorrhage:

Good prognosis: BUT:

- changes in LOC leads to decreased lucidity which leads to sudden deterioration

- the course is quick; the brain is rapidly pushed away from the
  skull which leads to compression, then edema, then
  herniation

Dx: CT Scan

RX: SX, burr holes, evacuate, ligate bleeding vessel.
2. INTRACEREBRAL HEMATOMA

- with head injuries: 2-3%
- bleed into cerebral areas
- R/T contusions

S&S:

- unconscious immediately
- starts with H/A which leads to loss of consciousness; which leads to coma and
hemiparesis; which leads to herniation and death

Dx: CT scan

RX: Craniotomy and evacuation; not always beneficial

                                   HIGH MORTALITY!

3. SUBDURAL HEMATOMA

- 10-15% cases
- source venous
- Arachnoid layer adheres to brain and bleeds into subdural
  space
- symptoms appear slowly

What happens?:

   - immediate direct pressure on brain
   - rupture small vessels

Types:

1. - Acute: high mortality d/t rapid decompression of brain
    (hemorrhage, compression, edema, herniation, death);
   - symptoms develop in 48 hours
   - associated with major trauma
   - H/A, drowsy, confusion, continues until pupils are fixed!

2. - Subacute: develops in 2 days- 2 weeks; S&S same as with
     acure; no worsening level of consciousness

3. - Chronic: as a result of minor injuries; develops S&S
     months later; hematoma encased, grows
    S&S: increased H/A, drowsiness, seizure, confusion

    NB: Elderly have more free space; therefrore it takes
        longer for symptoms to develop

4. SUBARACHNOID HEMORRHAGE

Causes: i) aneurysm; ii) hemorrhagic strokes

S&S: is sudden; loss of consciousness; death

Dx: - LP
     - if patient unconscious: increased ICP leads to coma
     - if patient conscious: H/A+++, N&V, Seizure, increased
       temperature

RX: - threat re-bleed first two weeks
     - if zero aneurysm: prognosis is good
     - if aneurysm: it is dependent on size, type,location, etc.

Nursing Considerations:

1. Baseline neuro assessment
2. Increase HOB/CBR
3. Monitor
4. Maintain ICP with diuretics, Mannitol, stool softeners

				
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posted:8/21/2012
language:Latin
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