A cerebrovascular incident, or stroke, is a compromise of the blood vessels to deliver blood to an area of the brain, potentially causing brain damage. It can either be an occlusion of the vessel lumen, known as ischemic stroke, or a rupture of the supplying vessel, known as ischemic stroke. The biggest risk factor for the development of hemorrhagic stroke is increased blood pressure, or hypertension. A hemorrhagic stroke is accompanied by a variety of symptoms.
Typical Symptoms
Hemorrhagic stroke usually is very sudden in onset, with vomiting, very high blood pressure and neurologic deficits that worsen very fast. These are typical characteristics of hemorrhagic stroke; however, sometimes patients do not have these "classic" findings and the presentation looks a lot like ischemic stroke.
Sensory Deficits
Patients can present with sensory deficits like altered sensation, tingling and numbness (usually on the opposite side of the body). Deficits can be worse in the upper or lower limbs, depending on the distribution of the affected vessel.
Motor Deficits
Patients can also have problems with motor function resulting from hemorrhagic stroke. Weakness, spasticity and even paralysis can result, with the deficits being worse in different limbs depending on stroke vessel distribution.
Mental Status
Patients with hemorrhagic stroke have a propensity to have a decreased level of consciousness, and even seizures. Both are indications for inserting a breathing tube (intubation) due to the potential for the body to lose the airway in both these events; this usually necessitates a stay in the intensive care unit.
Lack of Pupil Reactivity
This can result from bleeding that can compress cranial nerve III. It has parasympathetic fibers that course on the outside of the nerve; thus compression will affect those fibers first, and since they are responsible for reactivity of the pupil to light, this reflex will be lost before pupil size is affected (which is controlled by cranial nerve III). Thus the papillary exam can not only help localize the location of the insult, but also its progression.
Ataxia (Clumsiness)
This is primarily the result of a hemorrhage in the cerebellum. Usually the clumsiness affects the same side of the body as the lesion in the cerebellum.
Aphasia
Problems with communication, also known as aphasia, can result, especially with hemorrhages of the middle cerebral artery. These include Wernickes Aphasia, which is an inability to process communication; and Broca's Aphasia, which is normal understanding but an inability to communicate back.
Horner's Syndrome
This syndrome results from damage to the sympathetic nerves. Its clinical features include drooping of the upper eyelid, constriction of the pupil and decreased sweating on the same side of the face as the lesion. This is especially common in strokes of the cerebellum, medulla (brainstem) and thalamus.
References
- "Neurology in Clinical Practice, 5th Edition;" Bradley; 2008
- "Rosen's Emergency Medicine, 7th Edition;" Marx; 2009
- "The Osler Medical Handbook, 2nd Edition;" Piccini & Nilsson; 2006
