Pathophysiology of Hemorrhagic Stroke

The main type of hemorrhage that can lead to stroke is subarachnoid hemorrhage. In this type of bleed, which usually results from head trauma or a ruptured aneurysm, there is uncontrolled bleeding between the innermost two of the three meninges (membranes lining the brain), the pia mater and the arachnoid mater. The blood that pools or collects in a subarachnoid bleed is called a hematoma. Ischemia (lack of blood flow) from the hematoma is a secondary problem. It is caused by constriction of the arteries (vasospasm) as a protective response to reduce bleeding. About 25% of patients with subarachnoid hemorrhages will experience stroke symptoms resulting from secondary ischemia. Another common type of brain hemorrhage is an intracerebral hemorrhage, in which an artery inside the brain tissue fails due to high blood pressure and begins to bleed. It usually results from hypertension, but other causes of burst intracerebral arteries include various types of aneurysm, brain tumors, and blood clotting disorders. Symptoms of intracerebral hemorrhages can mimic symptoms of ischemic stroke, especially for smaller bleeds, but the two problems have different etiologies and treatments.

The pathophysiology of hemorrhagic stroke depends on the cause and type of cerebrovascular disorder. Symptoms are produced when a primary hemorrhage, aneurysm, or AVM presses on nearby cranial nerves or brain tissue or, more dramatically, when an aneurysm or avm ruptures, causing subarachnoid hemorrhage ( hemorrhage into the cranial subarachnoid space). Normal brain metabolism is disrupted by the brains exposure to blood; by an increase in icp resulting from the sudden entry of blood into the subarachnoid space, which compresses, and injures brain tissue; or by secondary ischemia of the brain resulting from the reduced perfusion pressure and vasospasm that frequently accompany subarachnoid hemorrhage.

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Cerebrovascular accidentor stroke (also called brain attack) results from sudden interruption of blood supply to the brain, which precipitates neurologic dysfunction lasting longer than 24 hours. Stroke are either ischemic, caused by partial or complete occlusions of a cerebral blood vessel by cerebral thrombosis orembolism or hemorrhage (leakage of blood from a vessel causes compression of brain tissue and spasm of adjacent vessels). Hemorrhage may occur outside thedura (extradural), beneath the dura mater (subdural), in the subarachnoid space (subarachnoid), or within the brain substance itself (intracerebral). Risk factors for stroke include transient ischemic attacks (TIAs) warning sign of impending stroke hypertension, arteriosclerosis, heart disease, elevatedcholesterol, diabetes mellitus, obesity, carotid stenosis, polycythemia, hormonal use, I.V., drug use, arrhythmias, and cigarette smoking. Complications of strokeinclude aspiration pneumonia, dysphagia, constractures, deep vein thrombosis, pulmonary embolism, depression and brain stem herniation