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INTRODUCTION
A Cerebrovascular disorder or CVA is damage to part of the brain when its blood
supply is suddenly reduced or stopped. A CVA may also be called stroke. The part of the
brain deprived of blood dies and can no longer function. Blood is prevented from
reaching brain tissue when a blood vessel leading to the brain becomes blocked
(ischemic) or bursts (hemorrhagic). The symptoms of a stroke differ, depending on the
part of the brain affected and the extent of the damage. Symptoms following a stroke
come on suddenly and may include: weakness, numbness, or tingling in the face, arm, or
leg, especially on one side of the body trouble walking, dizziness, loss of balance, or
coordination inability to speak or difficulty speaking or understanding, trouble seeing
with one or both eyes, or double vision, confusion or personality changes, difficulty with
muscle movements, such as swallowing, moving arms and legs, loss of bowel and
bladder control, severe headache with no known cause, and loss of consciousness.
Ischemic stroke, cerebrovascular accident (CVA), or “brain attack” is a sudden
loss of the blood supply to a part of the brain. Ischemic strokes are subdivided into five
different types based on the cause: large artery thrombosis strokes (20%), small
penetrating artery thrombotic strokes (25%), cardiogenic embolic strokes (20%),
cryptogenic strokes (30%) and other (5%).
Hemorrhagic strokes account for 15% to 20% of cerebrovascular disorders and
are primarily caused by intracranial or subarachnoid hemorrhage. Hemorrhagic strokes
are caused by bleeding in the brain tissue,the ventricles, or the subarachnoid space.
Primary intracerebral hemorrhage from a spontaneous rupture of small vessels accounts

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for approximately 80% of hemorrhagic strokes and is caused chiefly by uncontrolled
hypertension. Subarachnoid hemorrhage results from ruptured intracranial aneurysm in
about half the cases.
Many studies were conducted regarding cerebrovascular accidents tackling
different aspects of cerebrovascular accident such as; the cause, precipitating factors,
predisposing factor, and its prevalence throughout the world as one of the top ten leading
causes of morbidity.
The severity associated with cerebrovascular accident can best be demonstrated
by the following facts: CVA is the leading cause of adult disability in the world.

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NURSING HEALTH HISTORY
A. INITIAL DATA
Hospital Ospital Ng Maynila Medical Center
Chief Complaint Left sided weakness with slurry speech
Date Of Admission June 17,2011
Time Of Admission 11:00 am
Mode Of Admission Wheelchair
Ward From Emergency Room, she was
transffered to Medicine Ward last june 17,
2011
General Appearance Upon admission to the ER, the patient
verbalize of sudden onset of left sided
weakness upon waking up.
Admitting Diagnosis To Consider Cerebrovascular Accident
(CVA) Hemmorhagic
B. DEMOGRAPHIC DATA
Patient Name Mr. DA
Address Pasay City
Age 45 years old
Date of Birth --
Sex Male

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Occupation House Keeping Supervisor
Nationality Filipino
Marital Status Single
Religion Seventh Adventist
Usual Source Of Health Care --
C. CHIEF COMPLAINT
Client was brought in to hospital after experiening left-sided weakness asssociated
with slurring of speech.
D. HISTORY OF PRESENT ILLNESS
5 years prior to admission (2005)
3 years prior to admission (2007)
5 months prior to admission
1 hour prior to admission The patient had sudden onset of left-sided
weakness upon waking up, causing him to
fall off the sofa. Weakness was associated
with slurring of speech. No loss of
consciousness, no fever, and no vomiting
was noted.
Few minutes prior to admission On the way to the hospital, patient had an
episode of vomiting, non-projectile, about

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50 cc in volume.
E. PAST MEDICAL HISTORY
Medical History
Surgical History The client did not undergone any surgery.
Allergies The client verbalized that he has no
allergies on medications and drugs.She also
added that she has no allergies to any kinds
of foods.
Injuries/accidents He did not experienced any major
accidents.But had minor injuries because of
minor accidents.
F. FAMILY HISTORY
Family Medical History
G. SOCIAL HISTORY
Alcohol Use The client drink occassionally as stated by
his brother.

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Drug Use Patient verbalized that he is not taking any
prohibited drugs or medications.
Tobacco use Patient verbalized that he is smoking
sometimes.
I. HEALTH MAINTENANCE ACTIVITIES
Sleep According to the patient’s daughter, her
mother usually sleeps from 10pm to 4pm or
5-6 hours of sleep per day because she
prepared early the foods they will sell.
Diet According to patient’s daughter and
husband, the client likes to eat salty and
fatty foods. The client is also fond of eating
"isaw and adidas".
Exercise The client exercise is walking every
morning as she goes to the matket. The
informant said that she assist her rmother
when going to the market whcih is their
form of exercise. As of hospitalization,
client’s daughter assisted her mother on her
daily exercise like a simple rotation and
flexion of extremities.
Elimination According to client’s daughter, the client

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usually has one bowel movement every
morning before she was hospitalized. As
she was hospitalized her bowel movement
is every other day and she has an
indwelling catheter attached to urine bag.
PHYSICAL EXAMINATION

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Physical examination follows a methodical head to toe format in the
Cephalocaudal assessment. This is done systematically using the techniques of
inspection, palpation, percussion and auscultation with the use of materials such as the
penlight, thermometer, tape measure and stethoscope and also the senses. During the
procedure, the researchers made every effort to recognize and respect the patient’s
feelings as well as to provide comfort measures and follow appropriate safety
precautions.
♦ General Survey ♦
The client is a 45 year-old male. Upon assessment on June 30, 2011, the client is
weak in appearance. Appears and behaves to be as her apparent age. He has a fair skin
complexion and body built.
Interaction and answering of questions was done with the client and with the help
of his brothers, who were staying at the hospital to look after him.
The client has a temperature of 36.8oC, pulse rate of 82 bpm, and respiratory
rate of 24bpm and blood pressure of 150/90 mmHg. Client is afebrile and with some
alterations in the client’s BP and respiratory rate.
Area of
Assessment
Type of
Assessment
Used
Results Analysis
Head - Inspection The client’s head is proportionate
to the body size, There were no
tenderness in the scalp. There
were no presence of nodules, and
infestation. Her hair is evenly
The client has a normal
head size and shape. Her
hair is consistently
distributed and has a
normal color. The face is

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Eyes
Ears
- Inspection
- Inspection
and Palpation
distributed and the strands are
thin and brittle. The color of her
hair is a mixture of white and
black. Her head is round and
symmetrical its consistency is
hard. She can’t control her head
and the shape of his face is round
and asymmetrical and its
consistency is soft. She feels pain
on the left side of her head.
The condition of her eyes is
straight normal; the eye brows
are evenly distributed. Eyelids
have effectively closure. The
blink response is bilateral, eye
balls are symmetrical, the
palpebral conjunctiva is pink and
the sclera is white. The corneal
sensitivity reflex is present
cornea is transparent, the color of
his eyes are brown, the shape are
equal, it is uniform in color.
Pupils are equal in size. Pupils
are equally round and reactive to
light and accommodation. She
experiences blurred vision upon
assessment.
The color of the ear is of normal
racial tone which is brown, it is
asymmetrical and has
difficulty showing her
expressions. Pain is also
manifested on her facial
expression.
Her eyes appeared normal
physically. She doesn’t
have any eye defects and
but has difficulty on
visualization.
The ears have a normal
appearance. It doesn’t

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Nose
Mouth
Skin
- Inspection
and Palpation
- Inspection
- Inspection
symmetrical. The alignment of
the pinna is symmetrical. The
pinnas are elastic and recoil when
folded. The auditory canal
contains some cerumen, the color
is brown and there is an absent of
discharges.
The color of the client’s nose is
of racial tone which is brown.
Her septum is in the midline. The
mucosa is pink, nostrils are both
patent, nasal flaring is absent.
There is an NGT in his left
nostrils.
The lips is symmetrical and pink,
the consistency is smooth, buccal
mucosa is pink, the gum is pink,
the tongue is in the midline, the
color is pink and it is smooth.
The tongue movements are not
that smooth. Its texture is rough.
The color of the hard and soft
palate is pink. And it is intact.
There is presence of mucous.
Uvula is in the midline, gag
reflex is absent. The teeth are
incomplete.
The client’s skin is of normal
have any abnormal
discharges and functioning
normally without any
hearing aids.
The nose has a normal
color, shape and
consistency. She has a
normal breathing airway
through her nose with
some difficulty.
The mouth is functioning
normally. The client had
difficulty in performing
oral hygienic care for her
condition.
Skin is in normal finding.

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Neck
Chest and
Lungs
Abdomen
and Palpation
- Inspection
and Palpation
Inspection,
palpation and
Auscultation
Inspection,
Palpation
and
Auscultation
racial tone which is brown. It is
dry and smooth. The skin turgor
is wrinkled and loss of elasticity.
The body hair is evenly
distributed. She doesn’t have any
edema but she has a skin lesion
on her hand.
The neck has involuntary
movement and with resistance,
The trachea is in the midline,
thyroid is in the midline and it is
smooth. Maxillary lymph nodes
are palpable.
The color of the chest is of
normal racial tone which is
brown. There is absence of
intercostals retraction, chest wall
are symmetrical, and the chest
expansion is symmetrical.
Wheezing sound is heard upon
auscultation.
Skin is of normal racial tone
which is brown, the contour is
flat. Peristalsis is non-visible.
The color of her stool is brown, it
is semi formed.When palpated
she doesn’t have any tenderness
and when light palpation is done
Elasticity is loss due to
aging.
The neck movements are
not coordinated and with
signs of pain and
discomfort which are due
to neuromuscular
impairment.
The chest and lungs are
normal in appearance and
functioning. Wheezing is
present due to the patient’s
cough.
The abdomen of the client
is normal in appearance
and functioning.

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Upper
extermities
Lower
Extremities
- Inspection
and Palpation
- Inspection
and Palpation
muscle guarding is absent. The
liver is not palpable.
The client cannot resist force
when asked to resist. She has a
skin lesion in her right hand and
some scars on her left hand. The
peripheral pulses are equal.
Lymph nodes are not palpable.
The IV site is in her left arm.
Lack of sensation is present on
her right arm. She has edema on
both hands and graded as 2+.
The client cannot resist force
when asked to resist. She doesn’t
have any deformity. The
peripheral pulses are equal.
Lympnodes are non-palpable. No
lesions are observed and the
client is still unable to ambulate.
Bth feet have edma present and
graded as 2+.
The client has complete
upper extremities with
normal findings. Lesions
are present. Right side
functioning is altered due
to neuromuscular
impairment.
The client has complete
lower extremities. They
have normal skin color,
texture, moisture without
any edema, lesions and
varicosities. Functioning is
altered on the right side
due to neuromuscular
impairment.
GORDON’S TYPOLOGY
HEALTH
PATTERN
BEFORE
HOSPITALIZATION
AFTER
HOSPITALIZATION
INTERPRETATION
Health Upon asking, the The patient and her Health was given

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Perception/
Health
Management
Pattern
patient nodded that she
didnt follow doctor’s
prescription and
advices regarding her
health status.
family had perceived
the importance of
proper caring for her
health since she was
admitted.
importance after
realization of client’s
status upon
hospitalization. She
understands and
develop awareness on
her health condition
and needs to be
teaches more about her
health condition.
Nutritional
Metabolic
Pattern
The patient usually eat
foods that is high in
cholesterol but since
she was diagnosed of
being hypertensive she
gradually avoided this
kind of foods.
Since hospitalization,
the patient is on soft
diet and IVF of PNSS
for rehydration and
nutritional
requirements.
There is a change in
eating pattern of the
patient; she is
restricted to take salty
and fatty foods and she
need to have a good
eating pattern and a
choice of a good food
that will sustain her
nutritional needs.
Elimination
Pattern
The client have a good
elimination pattern in
terms of her stool and
Since the patient was
hospitalized, she
experience difficulty in
The client has a
catheter attached to
urine bag, she tends to

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urine. fecal elimination. She
defecate every other
day. She has an
indwelling catheter
attach to the urine bag.
urinate more often
during hospitalization
than before , due to the
medications given to
her. But her metabolic
process undergoes
changes because of
decrease activity due
to her condition.
Activity-
Exercise
Pattern
Upon asking the patiet
if she has any activity,
the patient nodded yes
and sign walking when
asked what activity and
exrcise she is doing.
This has connection
with her work as a
eatery vendor.
The patinet nodded yes
upon asking if she was
assisted by her
daughter in doing
simple exercise like
flexion and extension
of her extremeties.
The patient
experiences huge
changes on her activity
and exercise for she
was now depending on
her daughter. Thus,
significant others play
a great role on helping
the patient cope up on
her health condition.
Sleep-Rest
Pattern
The patient lack
enough sleep and rest.
It is because of her
work that she needs to
Since the patient was
hospitalized, she has
increase time to sleep
and take a rest to
The patient did not
sustain enough sleep
and rest periods
because of her work.

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sleep late at night and
woke up early. When
asked what time she
ususally sleeps, the
patient show her both
hands which signifies
10pm. When asked on
what time she usually
woke up, she sign 4am.
sustain her needs. Whe she was
hospitalized, she got
more time to sleep and
rest.
Cognitive
Perceptual
Pattern
The patient is aware on
her health condition.
Thus she know very
well what might
happen but because her
family is unable to
provide financial
assistance to provide
enough care, she has
no choice but to ignore
this.
She realizes the
importance of her
health condition when
she was hospitalized.
With her family,
The patient is aware
on her health condition
and didn’t follow
doctor’s advice and
prescription. Thus, her
disease progresses,
which when she seek
advice from health
care professionals.
Therefore, she realizes
the importance of
maintaining health
lifestyle.
Role- The client said that the Since the client was She had a good

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Relationship
Pattern
relationship of their
family members are
good, sometimes she
was caring for her
daughter’s son.
admitted in the
hospital, she is
dependent on her
daughter, husband and
sometimes to the other
family members.The
family became her
source of strenght
while recovering on
her disease.
supportive family
which she needed on
her situation now. It is
also needed that her
family should adapt to
changes in the role and
responsibilities of the
patient..
Value- Belief
Pattern
The patient was a
Roman Catholic and
she usually go to
church every Sunday.
She also said that there
are times when she
cant attend mass when
she is feeling sick or
weak.
Since the patient was
admitted in hospital
she can’t go to church
that’s why she said that
she was prayed before
starting the day and
before sleeping.
The client’s values and
beliefs become
stronger after
hospitalization and it
influence how active a
role is.

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Sexuality/
Reproduction
Pattern
The client said that
she was not sexually
active because of her
age.
Since the client was
admitted to the
hospital she was not
sexually active
because of her
condition.
The client was not
sexually active
anymore.
Coping/Stress
tolerance
The patient said that
when she had a
problem she doesn’t
told it to anyone of
the member of the
family instead as a
coping mechanism
she usually eats
barbeque.
Because of her
condition right now
the patient can talk to
her daughter of what
she feels for her
illness.
The patient eats
barbeque whenever
she feels stressed to
compensate for such
stressful moments
before hospitalization.
But during
hospitalization she
always talk to her
daughter because of
her condition
REVIEW OF SYSTEMS
General The client nodded, implying “Oo” when she was asked if
nahihirapan siyang gumalaw at magsalita dala ng kanyang

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karamdaman.
The client gained weight and experienced weakness in the
right part of her body.
Skin The client has edema on the hands and on both feet with a
grade of 2+.
Head, Eyes, Ears, Nose, Throat
(HEENT)
Head: The client nodded her head, implying “Oo” when she
was asked if she was experiencing headache.
Eyes: The client nodded, implying “Oo” when she was asked
if she has blurring of vision and if her eyes are painful.
Ears: The client shook her head, implying “Hindi” when she
was asked if there is painful sensation in her ears. The
client’s has a good hearing because she can respond to the
question upon interviewing but she can’t speak normally.
She has a slurred speech because of her condition.
Nose: The client doesn’t experienced colds but she usually
experienced itching in her nostril because of her NGT.
Throat: The client had cough.
Respiratory The client nodded, implying “Oo” when she was asked if she
had cough.
Wheezing sound was heard upon auscultation.

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Cardiovascular The client nodded, implying “Oo” when she was asked if she
experiences chest pain.
Gastrointestinal
The client has NGT because of her condition, she can’t used
her mouth to chew and has difficulty chewing and
swallowing.
Genitourinary
The client has a foley catheter and have a normal urine
output and color as monitored in the urine bag.
Musculoskeletal
The client shook her head, implying “Hindi” when she was
asked if her body joints are painful when her body is moved..
The client experiences weakness on her right part of the
body.
Neurologic
The client is sometimes not oriented on time but is able to
identify the person she is talking to and the place where she
is.
Hematologic The client shook her head, implying “Hindi” when she was
asked if she experiencing any bleeding (nose, gums).

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ANATOMY AND PHYSIOLOGY
Nervous System
The nervous system is the body's information gatherer, storage center and control system.
Its overall functions are to collect information about the body's external/internal states
and transfer this information to the brain (afferent system), to analyze this information,
and to send impulses out (efferent system) to initiate appropriate motor responses to meet
the body's needs.
The system is composed of specialized cells, termed nerve cells or neurons that
communicate with each other and with other cells in the body. A neuron has three parts:
1. the cell body, containing the nucleus
2. dendrites, hair-like structures surrounding the cell body, which conduct incoming
signals.

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3. the axon (or nerve fiber), varying in length from a millimeter to a meter, which
conduct outgoing signals emitted by the neuron. Axons are encased in a fat-like
sheath, called myelin, which acts like an insulator and, along with the Nodes of
Ranvier, speeds impulse transmission.
Typically a given neuron is connected to many thousands of neurons. The specific point
of contact between the axon of one cell and a dendrite of another is called a synapse.
Messages passed to and from the brain take the form of electrical impulses, or action
potentials, produced by a chemical change that progresses along the axon. At the synapse,
the impulse causes the release of neurotransmitters (like acetylcholine or dopamine)
and this, in turn, drives the impulse to the next neuron. These impulses travel very fast
along these chain of neurons -- up to 250 miles per hour. This contrasts with other
systems, such as the endocrine system, which may take many hours to respond with
hormones.
The nerve cell bodies are generally located in groups. Within the brain and spinal cord,
the collections of neurons are called nuclei and constitute the gray matter, so-called
because of their color. Outside the brain and spinal cord the groups are called ganglia.
The remaining areas of the nervous system are tracts of axons, the white matter, so-called
because of white myelin sheath. Tracts carrying information of a specific type, such as
pain or vision, generally have specific names. .
Major Divisions of the Nervous System
The nerves of the body are organized into two major systems:
 the central nervous system (CNS), consisting of of the brain and spinal cord,
 the peripheral nervous system (PNS), the vast network of spinal and cranial
nerves linking the body to the brain and spinal cord. The PNS is subdivided into:
1. the autonomic nervous system (involuntary control of internal organs,
blood vessels, smooth and cardiac muscles), consisting of the sympathetic
NS and parasympathetic NS
2. the somatic nervous system (voluntary control of skin, bones, joints, and
skeletal muscle).
The two systems function together, with nerves from the periphery entering and
becoming part of the central nervous system, and vice versa.

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Brain Structures
The brain, the body's "control central," is one of the largest of adult organs, consisting of
over 100 billion neurons and weighing about 3 pounds. It is typically divided into four
parts: the cerebrum, the cerebellum, the diencephalon (thalamus, hypothalamus,
sometimes classed as cerebral structures) and the brain stem (medulla oblongata, pons,
midbrain), which is an extension of the spinal cord.
Cerebrum
The largest division of the brain, the cerebrum, consists of two sides, the right and
left cerebral hemispheres, which are interconnected by the corpus callosum. The two
hemispheres are "twins," each with centers for receiving sensory (afferent) information
and for intiating motor (efferent) responses. The left side sends and receives information
to/from the right side of the body, and vice versa. Various intellectual functions are
concentrated in either the left or right hemispheres.
The hemispheres are covered by a thin layer of gray matter known as the cerebral
cortex. The interior portion consists of white matter, tracts, and nuclei (gray matter)
where synapses occur. Each hemisphere of the cerebral cortex is divided into four "lobes"
by various sulci and gyri: The sulci (or fissures) are the grooves and the gyri are the
"bumps" on the brain's surface.

23. 23
The four lobes perform specific functions:
a) Frontal - controls fine movements (Betz cells)/ upper motor neuron) and smell.
Also, center for abstract thinking, judgment, and language (left hemisphere)
b) Parietal - coordinates afferent information dealing with pain, temperature, form,
shape, texture, pressure, and position. Some memory functions are also found here.
c) Temporal - handles dreams, memory, and emotions. Center for auditory function.
d) Occipital - governs vision
In addition to the four lobes, is the basal ganglia. The basal ganglia aggregates of
neurons (gray matter), constitute the extrapyramidal system. The extrapyramidal system
governs postural adjustment and gross voluntary movements, as opposed to fine
movements, controlled by the frontal lobe. The basal ganglia receive afferent input from
the cerebral cortex and thalamus. Their axons synapse in the brain stem and the spinal
cord.
Cerebellum
The cerebellum, the second largest brain structure, sits below the cerebrum. Like
the cerebrum, the cerebellum has an outer cortex of gray matter and two hemispheres. It
receives/relays information via the brain stem. The cerebellum performs 3 major
functions, all of which have to do with skeletal-muscle control:
Function summary:
 Balance/ Equilibrium of the trunk
 Muscle tension, spinal nerve reflexes, posture and balance of the limbs
 Fine motor control, eye movement. (Incoming information is transferred from the
cerebral cortex via the pons. Outgoing information goes back to the cortex via the
thalamus.)

24. 24
Cerebellar disease (abscess, hemorrhage, tumors, and trauma) results in ataxia (muscle
incoordination), tremors, and disturbances of gait and equilibrium. This can also interfere
with a person's ability to talk, eat, and perform other self care tasks. Paralysis does not
result from loss of cerebellar function.
Diencephalon
The diencephalon, located between the cerebrum and the midbrain, consists of several
important structures, two of which are the:
 Thalamus: large, bilateral (right thalamus/left thalamus) egg-shaped mass of gray
matter serving as the main synaptic relay center. Receives/relays sensory
information to/from the cerebral cortex, including pain/pleasure centers.
 Hypothalamus: a collection of ganglia located below the thalamus and associated
with the pituitary gland. It has a variety of functions: senses changes in body
temperature; controls autonomic activities and hence regulates the sympathetic
and parasympathetic nervous systems; links to the endocrine system/controls the
pituitary gland; regulates appetite; functions as part of the arousal or alerting
mechanism; and links the mind (emotions) to the body -- sometimes,
unfortunately, to the degree of producing "psychosomatic disease."
Brain-Stem
The medulla oblongata, pons, and midbrain (mesencephalon or cerebral
peduncles) -- often referred to collectively as the brain stem -- control the most basic life
functions. Of these three, the medulla is the most important. In fact, so vital is the
medulla to survival that diseases or injuries affecting it often prove fatal. All functions of
the brain stem are associated with cranial nerves III-XII.
Function summary:
 Breathing/respiration (pons, medulla)
 Heart rate/ action (medulla)
 Blood pressure (vasoconstriction)/ blood vessel diameter (medulla)
 Reflex centers for pupillary reflexes and eye movements (midbrain, pons); and for
vomiting, coughing, sneezing, swallowing, and hiccupping (medulla).

25. 25
Blood supply
An intricate arterial structure supplies the brain with oxygen-rich blood. At the brain
stem, two vertebral arteries, entering through the first cervical vertebrae, join to form the
basilar artery. The basilar artery along with two internal carotid arteries, entering through
holes at the base of the skull, interconnect at the Circle of Willis. From there, the anterior
and middle cerebral arteries arise; the posterior cerebral artery arises from the basilar
system.
Cranial Nerves
There are 12 pairs of cranial nerves. Some bring information from the sense
organs to the brain; some control muscles; others are connected to glands or internal
organs.
Cranial Nerves Major Function
I. Olfactory Smell
II. Optic Vision
III. Occulomotor Eyelid and eyeball movement
IV. Trochlear Innervates superior oblique turns eye
downward and laterally
V. Trigeminal Chewing face & mouth touch & pain
VI. Abducens Turns eye laterally
VII. Facial Controls most facial expressions secretion
of tears & saliva taste
VIII. Vestibulocochlear Hearing equilibrium sensation
IX. Glossopharyngeal Taste senses carotid blood pressure
X. Vagus Senses aortic blood pressure slows heart
rate stimulates digestive organs taste
XI. Spinal Accessory Controls trapezius & sternocleidomastoid,
controls swallowing movements
XII. Hypoglossal Controls tongue movements

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Pathophysiology
Precipitating Factors:
- Hypertension
BP: 200/140 mmHg
Predisposing Factors:
- Life style (sedentary)
- Age : 53 years old
- Diet :Salty and fatty
foods
Occlusion in major vessel
Atherosclerosis
Thrombosis
Hypertensio
n
Formation of Plaque deposits
Vascular wall becomes
weakened and fragile
Rupture of the affected
blood vessel
Cerebral Hemorrhage
Sx:, headache,
Unconsciousness,
visual
disturbances
CT Scan
 Acute
Intraparenchymal
hemorrahage

27. 27
Mass of blood forms and
grows
Vasospasm of
tissue and arteries
Formation of small
and large clots
Blood seeps into the
ventricles
CEREBRAL HYPOPERFUSIONSx:
dizziness,
confusion,
headache
Impaired distribution of
oxygen and glucose
Tissue hypoxia and cellular
starvation
Cerebral Ischemia
Initiation of ischemic
cascade
Lodges unto
other cerebral
arteries
Anaerobic metabolism by
mitochondria
Generates large amounts
of lactic acid
Metabolic Acidosis
Failure production of
adenosine triphosphatase
Failure of energy dependent
process
(ion pumping)
Production of oxygen free
radicals and other reactive
oxygen species
Release of excitatory
neurotransmitter glutamate
Influx of calcium
Damage to the blood
vessel endothelium
Activates enzymes that
digest cell proteins, lipids
and nuclear material
Failure of
mitochondria
Further energy
depletion

28. 28
Brain sustains an irreversible
cerebral damage
Release of metalloprotrease
(zinc and calcium-dependent enzymes)
Break down of collagen, hyaluronic acid and
other elements of connective tissue
Structural integrity loss of brain
tissue and blood vessels
Breakdown of the protective
Blood Brain Barrier
Cerebral edema
Vascular Congestion
Compression of tissue
Impaired perfusion and
function
Middle
Cerebral Artery
Lateral
hemisphere,
frontal, parietal
and temporal
lobes, basal
ganglia
S/Sx:
Contralateral
hemiparesis,
unilateral
neglect,
altered
consciousnes,
vision
changes,
aphasia,
memory
deficits,
headache,
slurry speech

29. 29
Laboratory and Diagnostic Procedures
I. Computed Tomography (CT) Scan
Scan:
There is an acute hemorrhage measuring about 3.1 x 4.3 x 3.8 cm (volume of
about 26 cc) predominantly involving the right thalamucapsuloganglionic region with
perilesional edema and intraventricular dissection. There is an associated compressive
effect to the right lateral ventricle with leftward midline shift of about 0.4 cm. The left
lateral ventricle and temporal horns are dilated. There is likewise some effacement of the
underlying sulci.
Incidental note of mucous retention cyst in the right maxillary sinus.
Impression:
Acute hemorrhage predominantly involving the right thalamucapsuloganglionic
region with intraventricular dissection for the associated and other findings, please see
body of the report.
II. Hematology
Date: Nov. 26, 2010
Components Result Normal Values

30. 30
Hemoglobin Count 13.5 12-14g/dl
Hematocrit 0.41 0.37-0.47
WBC count 14.2 4.8 − 10.8 𝑥10 9
Segmenters 85 60-70%
Lymphocyte 15 30-40%
Eosinopril 1-3%
Monocyte 2-8%
Stab 2-6%
Basophil 0-1%
Platelets 363 130-400x 10 9
ANALYSIS:
 Increased white blood cells indicate more disease-fighting cells in her body and
increased expected when body is fighting off an infection.
III. Urinalysis
Macroscopic
Physical Characteristics
Color: yellow
Transparency: slightly turbid

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Microscopic
Pus Cell: many
Red Cell : 1-4
Epithelial Cell: moderate
Mucus Thread: 0
Amorphous Urate: few
Chemical
Albumin: +
Sugar: -
Specific Gravity: 1.020
pH: 5
ANALYSIS:
All values profound to normal results. The color amber yellow is ideal and the slightly
turbid transparency is also a normal finding. The microscopic results suggest no
significant changes and alterations to its normal values.