INTRACEREBRAL HEMORRHAGE

Tiny arteries bring blood to areas deep inside the brain. High blood pressure (hypertension) can
cause these thin-walled arteries to rupture, releasing blood into the brain tissue. Enclosed within
the rigid skull, clotted blood and fluid buildup increases pressure that can crush the brain against
the bone or cause it to shift and herniate. As blood spills into the brain, the area that artery
supplied is now deprived of oxygen-rich blood – called a stroke. As blood cells within the clot
die, toxins are released that further damage brain cells in the area surrounding the hematoma.

Figure 1. An intracerebral hemorrhage (ICH) is usually caused by rupture of tiny arteries within
the brain tissue (left). As blood collects, a hematoma or blood clot forms causing increased
pressure on the brain.

An ICH can occur close to the surface or in deep areas of the brain. Sometimes deep
hemorrhages can expand into the ventricles – the fluid filled spaces in the center of the brain.
Blockage of the normal cerebrospinal (CSF) circulation can enlarge the ventricles
(hydrocephalus) causing confusion, lethargy, and loss of consciousness.

The following are the symptoms of ICH:

 headache, nausea, and vomiting

 lethargy or confusion
 sudden weakness or numbness of the face, arm or leg, usually on one side
 loss of consciousness
 temporary loss of vision
 seizures

Causes:
  Hypertension - elevated blood pressure may cause tiny arteries to burst inside the
brain
 Blood thinners: drugs such as coumadin, heparin, and warfarin used to prevent clots in
heart and stroke conditions may cause ICH.
 AVM: a tangle of abnormal arteries and veins with no capillaries in between.
 Aneurysm: a bulge or weakening of an artery wall.
 Head trauma: fractures to the skull and penetrating wounds (gunshot) can damage an
artery and cause bleeding.
 Bleeding disorders: hemophilia, sickle cell anemia, DIC, thrombocytopenia.
 Tumors: highly vascular tumors such as angiomas and metastatic tumors can bleed into
the brain tissue.
 Amyloid angiopathy: a buildup of protein within the walls of arteries.
 Drug usage: alcohol, cocaine and other illicit drugs can cause ICH.
 Spontaneous: ICH by unknown causes.

Risk factors:

 Age
 High blood pressure – weakens the walls of arteries

I. Biographic Data
Name: P.M.

Address: Gapan Nueva Ecija

Age: 54 y/o Gender: Female Religion: Born Again Christian

Marital Status: Married Occupation: Teacher

Room and Bed no.: Room 210 Bed D

Chief Complaint: Rigid extension of upper and lower extremities

Provisional Diagnosis: Intracerebral hemorrhage left capsuloganglionic area

II. Nursing history

A. Past Health History
Client was diagnosed Hypertension (2009). She is taking maintenance such as Metoprolol and
Losartan. She experienced Transient Ischemic Attack (2012). And she also diagnosed
Intracerebral hemorrhage left parietal (2015).
 Her daughter stated that she is not sure with her mother’s childhood illnesses and
immunizations. She also claimed that her mother is not allergic with any food. “Wala namang
pagkain na nakakapagdulot ng allergy sa kaniya, pati alikabok o halaman wala din.”
When asked about the client’s foreign travel, she reported that, “Hindi pa naman siya
nakakaalis ng bansa, dito lang kami sa Nueva Ecija.” She added that her mother has no foreign
travel for she is not interested in doing so nor she has money to finance for traveling.

B. History of Present Illness

According to the client’s daughter, her mother’s family have hypertension disease. Few
minutes prior to admission, the client experience rigid extension of lower and upper extremities
while chatting the boyfriend of her daughter. They decided to bring the client to the Perpetual
succor hospital but apparently the institution lack services they were advised to transfer to
another hospital, so they decided to bring her at USTH-ER and after checking and several tests,
client was diagnosed with intracerebral hemorrhage left capsuloganglionic area.

C. Family History

(+) Hypertension – Maternal side

PATHOPHYSIOLOGY

Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels
supplying the brain. Hypertension is the most important cause; it damages the blood vessel
lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a
repairing process which is not always complete and perfect. Sustained hypertension permanently
changes the architecture of the blood vessels making them narrow, stiff, deformed, uneven and
more vulnerable to fluctuations in blood pressure.

A fall in blood pressure during sleep can then lead to a marked reduction in blood flow in the
narrowed blood vessels causing ischemic stroke in the morning. Conversely, a sudden rise in
blood pressure due to excitation during the daytime can cause tearing of the blood vessels
resulting in intracranial hemorrhage. Cerebrovascular disease primarily affects people who are
elderly or have a history of diabetes, smoking, or ischemic heart disease. The results of
cerebrovascular disease can include a stroke, or occasionally a hemorrhagic stroke. Ischemia or
other blood vessel dysfunctions can affect the person during a cerebrovascular accident.
(http://en.wikipedia.org/wiki/Cerebrovascular_disease)

Changes in the blood pressure are sensed by the renal baroreceptors. If the blood pressure
is high release of renin is decreased. Renin circulates in the blood and act as enzyme to
convert the protein angiotensin to angiotensin I. Angiotensin II it is powerful vasoconstrictor
that primarily causes constriction of the small arterioles. This causes an increase in resistance
to blood flow and increase in blood pressure.

Sedentary lifestyle and food intake greatly affect the blood vessel because of possible
hyperlipidemia. If the client usually eats high salt and high fat food it will constrict the blood
vessel. ( handbook of Pathophysiology by Elizabeth J. Corwin )