Tuesday, April 15, 2014

Author Question: Cerebral Hemorrhage


Carol Asks:



I know that cerebral hemorrhages usually don't show symptoms, but for my plot, I want this young character to die quickly and not of an accident. I want foreshadowing of the event. I've given him headaches and tests will show he's got the bulging artery--they're going to fix it because it had leaked (thus the headaches.) He dies before that.

Is that plausible?

Jordyn Says:

Yes, this is plausible though I don't know if I would say cerebral hemorrhages usually don't show symptoms. This IS bleeding on the brain. Blood, where it shouldn't be, tends to be very irritating and will show up in symptoms (things that only the patient can tell us) and signs (things that we can measure.)

I did a post on the difference between signs and symptoms that you can find here

That being said, it also depends on the size of the bleed and the location of the bleed. With a very tiny bleed-- the patient may not experience any symptoms. I would say on the continuum that this would be more rare. If this aneurysm has started leaking already they may not want to postpone surgery. So, I think finding the bulging aneurysm is sufficient enough.

Other signs and symptoms of cerebral hemorrhage are:


  • Seizures
  • Weakness and/or numbness in an extremity
  • Nausea
  • Vomiting
  • Changes in vision
  • Hard to speak/Understand speech
  • Balance Issues

Don't forget the FAST acronym for stroke:
  • Face: Is their smile equal? If they stick out their tongue-- does is stray to one side and not stay in the middle?
  • Arms: Have the person lift both arms and hold them out with their palms up. If one hand turns inward or a whole arm drifts down this is called pronator drift and signals a neurosurgical emergency.
  • Speech: Have the person repeat a simple phrase. Is it clear or slurred and strange?
  • Time: If any of these are present call 911. 
In the hospital setting, I use this exact tool as a quick screening method for stroke (which can be either caused by bleeding or a clot.) A negative test doesn't mean something didn't happen-- it just means something isn't happening at that moment.

A friend of mine was recently on the phone with her father (who lives in another state) when he confessed to her that one of his arms had gone completely numb. She instructed him to call 911-- which he did and his symptoms completely resolved by the time he got to the ED. However, he did have a transient ischemic attack (or TIA) or mini-stroke which increases his risk of a bigger event happening in the future.

For more information about cerebral hemorrhage (or stroke) you can check out this link.  

Also, these You Tube videos have a very nice, simple explanation of the genesis of stroke.


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Give Carol McClain a challenge, she’s happy. Her interests vary from climbing high ropes to playing the bassoon to Habitat for Humanity and to stained glass creation. If it’s quirky or it helps others, she loves it. Significant Living, Vista, and Evangel have published her non-fiction articles. In her spare time, she coordinates the courses for ACFW, is team leader for The Christian Pulse, and has written four novels. She lives in upstate New York with her husband, a retired pastor, and their overactive Springer spaniel. You can read her work at http://carol-mclain.blogspot.com.

8 comments:

  1. From the SHR archives ::barf::
    https://www.youtube.com/watch?v=Jq2pqKTzC5g

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    1. Excellent, Drew!! I'll try to put this on Sunday's post.

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  2. Jordyn, rather than an aneurysm, the author may wish to consider an A-V (arteriovenous) malformation of the brain, foreshadowed by transient ischemic episodes (TIAs) rather than headache, and culminating in a massive rupture and death.

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    1. Great suggestion, Richard. Always love your insight.

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  3. Great question and answer. Thank you for sharing! Love learning from your blog.

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    1. Awww--- thanks, Mart. Always good to see you here.

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  4. In the FAST, I thought T stood for "Tongue" - as in checking to see if the patient could stick out their tongue. What does the T as "Time" mean?

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    1. It's important to know when the patient was last "normal" for the medical staff. This will help determine if clot busting drugs can be given. They are time sensitive.

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