Hemmoragic Stroke

[lovinmytwins]

If a bleed is getting noticably worse, is it appropriate to wait before providing surgical intervention? Is over 24 hours appropriate? If not, could earlier surgical intervention prevented the ischemic stokes that followed? (Pleas forgive any typos. I'm exhausted!!! :0) )

[katiescow]

It would all depend on the patient My grandmother for example 84, passed away after having hem. stroke last week they took her into the ER and the x-ray right away showed the Dr.'s she had the stroke but they kept her overnight to monitor for more stroke activity and did a CT on Wednesday confirming she was bleeding in the brain (she was also on blood thinner medications for heart issues) they decided then not to go through with a surgery to stop the bleeding because odds were she wouldn't make it through the surgery so they made her comfortable & waited for the pressure to build and everything to start shutting down on their own.

[ayla2004, ASN, RN]

If it's a sah then ebp says protect within 6 hours, Not always possible not all are easily coiled or clip some woold be too high risk on the table. Ich are in my experience better evacuated eArly before the person icp rises and gcs drops.

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[prep8611]

Neurosx will usually try to coil asap and get a venticulostomy if pt is gonna have hydrocephalus(likely). I work neuroscience icu now and are treatments are rapid if the patients gcs is dropping but if a patient with a small sah comes in scaled at 15 they won't go in till the am( I work nights). All sah pts get put on nimotop for spasm as it is standard of care.

[ayla2004, ASN, RN]

Yup are grade 1 sah plan is to try to treat in the am. I say try cause I know of 2 0patient I have nursed who were uncoilable. We nurse grade 1 0n the wa. Early hydrocephalus get evd.

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[ayla2004, ASN, RN]

nimodpine and 3l with fbr as standard.

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[misswoosie]

SAH isn't usually classified as a Hemorrhagic stroke- it's a SAH! To answer the OP it really depends on the location and size of the bleed and the patients condition and comorbidity.

[N8inChatt]

SAH is a form of stroke. It can be the result of an aneurysm. Hemorrhagic strokes can be either ICH or SAH.

[misswoosie]

Yes technically it is, BUT, clinically, if someone has a SAH it is referred to as a SAH-not a hemorrhagic stroke. Part of the reason for this is that the risk factors and pathology are different from hemorrhagic and ischemic strokes.The most common cause of non traumatic SAH is an aneurysm. Other causes include vascular malformations, tumors, and infection. Unlike hemorrhagic or ischemic strokes it's most common in 40-40 yr olds and almost twice as common in women as in men. The bleeding occurs in the sub-arachnoid space in a SAH, rather than in the cerebrum. The risk factors aren't the typical stroke vascular risk factors, although they do think smoking and perhaps hypertension increase risk.

[N8inChatt]

I understand the risk factors and pathology that you are listing but that does not take away from the fact that it is referred to as a hemorrhagic stroke. SAH are among the least common of the hemorrhagic strokes but they are still classified as strokes nonetheless.