Cerebral Haemorrhage
Cerebrovascular Accident (CVA)
A CVA (stroke) is an acute medical emergency. Stroke is a disease of the circulatory system caused by the rupturing or the blockage of an artery that supplies part of the brain. Depending on where the rupture or blocked artery leads, this part of the brain does not get oxygen. This can result in permanent brain damage, disability and sometimes death.
Transient Ischaemic Attack
"TIA" is a transient ischemic attack or episode that describes when part of the brain is not getting enough oxygen for a short period of time. It causes symptoms of stroke that appear, but then subside. Symptoms are focal and usually consist of weakness and numbness. Symptoms can last a few minutes or up to 24 hours before improving.
Subarachnoid Haemorrhage
A subarachnoid haemorrhage is one that occurs in the space that lies between the first and second membranes around the brain, which is called the arachnoid. A subarachnoid haemorrhage occurs under this layer. The commonest symptom of a subarachnoid haemorrhage is the onset of a sudden headache, (like a blow to the head is how PT's describe it) that will become the most intense headache the patient has ever experienced. Be prepared for the patient to go unconscious or even have a seizure.
Signs and Symptoms
When a section of the brain is deprived of oxygen, neurological symptoms result, such as:
- Loss of vision in one eye (or other vision changes)
- Confusion
- Vertigo
- Inability to speak
- Numbness or weakness of one side of the body
- Severe headache (often described as a blow to the back of the head when somebody is having a subarachnoid haemorrhage)
- Asymmetrical drooping of the face
- Flushed complexion
- Noisy breathing
- Cerebral irritation due to hypoxia
- Hypertension
- Possible seizures caused by hypoxia.
Not all the above are present at one time, so a slow methodical approach should lead you to diagnose a possible CVA has occurred.
Management
Reassurance, O2 as per Oxygen guidelines, Monitoring vital signs. Carry out a blood sugar test on all patients who present with Stroke like symptoms and/or reduced level of consciousness.
With a patient who may of experienced a CVA carry out the FAS Test
F - Facial palsy. Get the patient to give you a toothy grin and look for difference in symmetry
A - Arm weakness. Ask the patient to close their eyes. Lift both arms to a horizontal position. If one of the arms drops then this indicates a weakness. Also get the patient to grip both your hands and to give them a good squeeze, again feeling if one hand is weaker.
S - Speech. Ask the patient to repeat a simple sentence, this will allow you to hear whether or not any slurring of words are present.
ASHICE (Consider)
Transport to Hospital
Professional Handover
Updated April 2012