1. Extradural space Subdural space



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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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