AANN Core Curriculum, 7th Edition, Ch. 18 Hemorrhagic Stroke: Digital Version-Chapter 18

Chapter 18

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Hemorrhagic vascular events include intracerebral hemorrhage (ICH), unruptured intracranial aneurysms (UIAs), subarachnoid hemorrhage (SAH), and spinal vascular malformations. These conditions can cause severe neurological injury and require rapid assessment and treatment.

<strong>ICH</strong> is bleeding into brain tissue, most often associated with chronic hypertension or cerebral amyloid angiopathy; anticoagulants, vascular lesions, tumors, and other disorders are additional causes. Hematoma expansion, edema, raised intracranial pressure (ICP), and rebleeding can lead to herniation or death. Noncontrast CT is the initial diagnostic test; vascular imaging, MRI, and laboratory studies help identify causes and complications. Care focuses on frequent neurological and blood-pressure monitoring, reversal of coagulopathy, ICP management, and, when indicated, hematoma evacuation or ventricular drainage. Seizures, hydrocephalus, and venous thromboembolism also require attention. Hypertension control and avoiding tobacco and illicit drugs help reduce risk.

<strong>UIAs</strong> are focal dilations of weakened arterial walls, often discovered incidentally. Rupture risk depends on factors such as size, location, shape, growth, symptoms, and family history. CTA, MRA, or cerebral angiography supports diagnosis and follow-up. Management ranges from surveillance and risk-factor control to surgical clipping or endovascular treatment.

<strong>SAH</strong>, commonly caused by a ruptured aneurysm, typically presents as a sudden, severe “worst headache,” sometimes with vomiting, neck stiffness, altered consciousness, or focal deficits. CT and vascular imaging guide diagnosis; lumbar puncture may be considered when CT is negative but suspicion remains. Early aneurysm securing by clipping or coiling reduces rebleeding risk. Care includes close neurological and blood-pressure monitoring, nimodipine, and surveillance for vasospasm, delayed cerebral ischemia, hydrocephalus, seizures, and cardiopulmonary or electrolyte complications.

<strong>Spinal vascular malformations</strong> may cause acute back pain, weakness, sensory loss, myelopathy, or bowel and bladder dysfunction. MRI evaluates cord injury, while spinal angiography guides treatment. Options include microsurgery, embolization, and radiosurgery; nursing care also addresses mobility, skin integrity, elimination, and patient education.

Keywords

intracerebral hemorrhage

unruptured intracranial aneurysm

subarachnoid hemorrhage

spinal vascular malformation

noncontrast CT

hematoma expansion

aneurysm clipping

endovascular treatment

vasospasm

spinal angiography