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