PATHOPHYSIOLOGY OF HYPERTENSIVE INTRACEREBRAL HEMORRHAGE

Legend: Etiology Disease process

Signs and symptoms

Modifiable risk factor: Cigarette Smoking Alcoholic

Non-modifiable risk factors: Genetics: Family Hx of HPN Age: 64 y.o.

Laboratory Studies

peripheral insulin resistance

Insulin does not bind into cell membrane Glucose cannot enter the cell glucose in the bloodstream

-cells in the pancreas increases insulin secretion to maintain balance between glucose and insulin in the bloodstream

-cells become exhausted and decreases insulin secretion Balance between insulin and glucose is disrupted

FBS:
glucose in the bloodstream

15.67 mmol/L
Body utilizes stored fats as food for the cells Stored fats are converted into glucose

Waste products (lipids) in the conversion process are secreted in the bloodstream

serum lipid in the bloodstream Lipid accumulate in the blood vessel wall Plaque builds up in the blood vessel wall Diameter of the blood vessel wall narrows Heart pumps harder to meet bodys O2demand pressure exerted by the blood on the blood vessel wall blood pressure blood flow through the blood vessel blood supply to the kidney Baroreceptors detects the decreased blood volume Renin is secreted Renin converts angiotensin to angiotensin I ACE in the lungs converts angiotensin I to angiotensin II RBC passes through the glomeruli membrane RBC, protein, sugar, and WBC escapes into the urine Urinalysis: RBC : 6-10/hpf WBC: 1-3/hpf Albumin: Positive Sugar: Positive Prolonged low blood supply

BLOOD CHEMISTRY REPORT Total Cholesterol: 5.08 mmol/L

Damage to glomeruli glomerular filtration

kidney tubular reabsorption

permeability of glomeruli membranes

kidney reabsorption

Na retains fluid glomerular filtration

Hypertension

Fluid accumulates in the interstitial space

Angiotensin II causes vasoconstriction blood pressure

urine output

Blood vessels in the brain burst Blood is released into the brain tissue

Non pitting edema at both upper and lower extremities

CT SCAN REPORT November 30, 2012 Impression: Intraparenchymal bleed (110 cc) centered in the left basal ganglia with intraventricular and minor subarachnoid extension

Blood pools in the left basal ganglia

Blood supply to the cerebral area is disrupted

Blood leaks into the lateral, third and fourth ventricles

O2 supply to brain cells is diminished

Dizziness Headache Numbness

Intracranial pressure is increased

Cells cannot proceed with aerobic respiration

Cells cannot proceed with aerobic respiration

Cells cannot proceed with aerobic respiration Less ATP is produced

Less ATP to power cellular activities Membrane pump fails Sodium and calcium ions will rush into the cell Glutamate will exit the cell

Cerebral cells begin to die

Brocas area is damaged

Damage to Left Frontal Lobe

Damage to brain stem

Motor control is diminished

Control of speech is diminished

Sensory perception diminished

Level of Consciousness is altered

Gag reflex is depressed Aphasia Decreased sensation

Quadriplegia Impaired swallowing

Coma