INTRODUCTION

A Cerebrovascular disorder or CVA is damage to part of the brain when its blood supply is suddenly reduced orstopped. A CVA may also be called stroke. The part of thebrain deprived of blood dies and can no longer function. Blood is prevented from reachingbrain tissue when a blood vessel leading to the brain becomes blocked (ischemic) orbursts (hemorrhagic). The symptoms of a stroke differ, depending on the part of the brainaffected and the extent of the damage. Symptoms following a stroke come on suddenlyand may include: weakness, numbness, or tingling in the face, arm, or leg, especially onone side of the body trouble walking, dizziness, loss of balance, or coordination inability tospeak or difficulty speaking or understanding, trouble seeing with one or both eyes, ordouble vision, confusion or personality changes, difficulty with muscle movements, suchas swallowing, moving arms and legs, loss of bowel and bladder control, severe headachewith no known cause, and loss of consciousness. Ischemic stroke, cerebrovascular accident (CVA), or brain attack is a sudden loss of the blood supply to a part of the brain. Ischemic strokes are subdivided into five different types based on the cause: large artery thrombosis strokes (20%), small

penetrating artery thrombotic strokes (25%), cardiogenic embolic strokes (20%), cryptogenic strokes (30%) and other (5%). Hemorrhagic strokes account for 15% to 20% of cerebrovascular disorders and are primarily caused by intracranial or subarachnoid hemorrhage. Hemorrhagic strokes are caused by bleeding in the brain tissue,the ventricles, or the subarachnoid space. Primary intracerebral hemorrhage from a spontaneous rupture of small vessels accounts

for approximately 80% of hemorrhagic strokes and is caused chiefly by uncontrolled hypertension. Subarachnoid hemorrhage results from ruptured intracranial aneurysm in about half the cases.

Many

studies

were

conducted

regarding

cerebrovascular

accidents

tacklingdifferent aspects of cerebrovascular accident such as; the cause, precipitating factors,predisposing factor, and its prevalence throughout the world as one of the top tenleading causes of morbidity.

The

severity

associated

with

cerebrovascular

accident

can

best

be

demonstratedby the following facts: CVA is the leading cause of adult disability in the world.

NURSING HEALTH HISTORY

A. INITIAL DATA Hospital Chief Complaint Date Of Admission Time Of Admission Mode Of Admission Ward Ospital Ng Maynila Medical Center Left sided weakness with slurry speech June 17,2011 11:00 am Wheelchair From Emergency Room, she was transffered to Medicine Ward lastjune 17, 2011 General Appearance Upon admission to the ER, the patient verbalize of sudden onset of left sided weakness upon waking up. Admitting Diagnosis To Consider Cerebrovascular Accident (CVA) Hemmorhagic

B. DEMOGRAPHIC DATA Patient Name Address Age Date of Birth Mr. DA Pasay City 45 years old -3

Sex Occupation Nationality Marital Status Religion Usual Source Of Health Care

Male House Keeping Supervisor Filipino Single Seventh Adventist --

C. CHIEF COMPLAINT Client was brought in to hospital after experiening left-sided weakness asssociated with slurring of speech. D. HISTORY OF PRESENT ILLNESS 5 years prior to admission (2005)

3 years prior to admission (2007) 5 months prior to admission 1 hour prior to admission The patient had sudden onset of left-sided weakness upon waking up, causing him to fall off the sofa. Weakness was associated with slurring of speech. No loss of consciousness, no fever, and no vomiting was noted. Few minutes prior to admission On the way to the hospital, patient had an

episode of vomiting, non-projectile, about 50 cc in volume.

E. PAST MEDICAL HISTORY Medical History Surgical History Allergies The client did not undergone any surgery. The client verbalized that he has no allergies on medications and drugs.She also added that she has no allergies to any kinds of foods. Injuries/accidents He did not experienced any major accidents.But had minor injuries because of minor accidents.

F. FAMILY HISTORY Family Medical History

G. SOCIAL HISTORY Alcohol Use The client drink occassionally as stated by

his brother. Drug Use Patient verbalized that he is not taking any prohibited drugs or medications. Tobacco use Patient verbalized that he is smoking sometimes.

I. HEALTH MAINTENANCE ACTIVITIES Sleep According to the patients daughter, her mother usually sleeps from 10pm to 4pm or 5-6 hours of sleep per day because she prepared early the foods they will sell. Diet According to patients daughter and

husband, the client likes to eat salty and fatty foods. The client is also fond of eating "isaw and adidas". Exercise The client exercise is walking every morning as she goes to the matket. The informant said that she assist her rmother when going to the market whcih is their form of exercise. As of hospitalization, clients daughter assisted her mother on her daily exercise like a simple rotation and flexion of extremities. 6

Elimination

According to clients daughter, the client usually has one bowel movement every morning before she was hospitalized. As she was hospitalized her bowel movement is every other day and she has an indwelling catheter attached to urine bag.

PHYSICAL EXAMINATION
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Physical examination follows a methodical head to toe format in the Cephalocaudal assessment. This is done systematically using the techniques of inspection, palpation, percussion and auscultation with the use of materials such as the penlight, thermometer, tape measure and stethoscope and also the senses. During the procedure, the researchers made every effort to recognize and respect the patients feelings as well as to provide comfort measures and follow appropriate safety precautions.

General Survey

The client is a 45 year-old male. Upon assessment on June 30, 2011, the client is weak in appearance. Appears and behaves to be as her apparent age. He has a fair skin complexion and body built. Interaction and answering of questions was done with the client and with the help of his brothers,who were staying at the hospital to look after him. The client has a temperature of 36.8oC, pulse rate of 82 bpm, and respiratory rate of 24bpm and blood pressure of 150/90 mmHg. Client is afebrile and with some alterations in the clients BP and respiratory rate. Type of Assessment Used - Inspection

AreaofAssessment Head

Results The clients head is proportionate to the body size, There were no tenderness in the scalp.There were no presence of nodules, and infestation. Her

Analysis The client has a normal head size and shape. Her hair is consistently distributed and has a normal color. The face is 8

hair is evenly distributed and the strandsare thin and brittle. The color of her hair is a mixture of white and black. Her head is round andsymmetrical its consistency is hard. She cant control her head and the shape of his face is roundand asymmetrical and its consistency is soft.She feels pain on the left side of her head. Eyes - Inspection The condition of her eyes is straight normal; the eye brows are evenly distributed. Eyelids have effectively closure. The blink response is bilateral, eye balls are symmetrical, the palpebral conjunctiva is pink and the sclera is white. The corneal sensitivity reflex is present cornea is transparent, the color of his eyes are brown, the shape are equal, it is uniform in color. Pupils are equal in size. Pupils are equally round and reactive to light and accommodation. She experiences blurred vision upon Ears - Inspection and Palpation assessment.

asymmetrical and has difficulty showing her expressions. Pain is also manifested on her facial expression.

Her eyes appeared normal physically. She doesnt have any eye defects and but has difficulty on visualization.

The ears have a normal

The color of the ear is of normal racial tone which is brown, it is symmetrical. The alignment of the pinna is symmetrical. The pinnas are elastic and recoil when folded. The auditory canal contains some cerumen, the color is Nose - Inspection and Palpation brown and there is an absent of discharges.

appearance. It doesnt have any abnormal discharges and functioning normally without any hearing aids.

The nose has a normal color, shape and

The color of the clients nose is of racial tone which is brown. Her septum is in the midline. The mucosa is pink, nostrils are both patent, nasal flaring is Mouth - Inspection absent. There is an NGT in his left nostrils.

consistency. She has a normal breathing airway through her nose with some difficulty.

The mouth is functioning normally. The client had

The lips is symmetrical and pink, the consistency is smooth, buccal mucosa is pink, the gum is pink, the tongue is in the midline, the color is pink and it is smooth. The tongue movements are not that smooth. Its texture is rough. The color of the hard and soft palate is pink. And it is intact. There is presence of mucous. Uvula is in Skin - Inspection the midline, gag reflex is

difficulty in performing oral hygienic care for her condition.

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and Palpation

absent. The teeth are incomplete.

Skin is in normal finding. Elasticity is loss due to aging.

The clients skin is of normal racial tone which is brown. It is dry and smooth. The skin turgor iswrinkled and loss of elasticity. The body hair is Neck - Inspection and Palpation evenly distributed. She doesnt have any edema but she has a skin lesion on her hand. The neck movements are not coordinated and with signs of pain and discomfort which are due The neck has involuntary movement and with resistance, Thetrachea is in the midline, Chest and Lungs Inspection, palpation and Auscultation thyroid is in the midline and it is smooth. Maxillary lymph nodes arepalpable. The chest and lungs are normal in appearance and functioning. Wheezing is present due to the The color of the chest is of normal racial tone which is brown. There is absence of intercostals retraction, chest Abdomen Inspection, Palpation and Auscultation Skin is of normal racial tone which is brown, the contour is flat. Peristalsis is non11 wall are symmetrical, and the chest expansion is symmetrical. Wheezing sound is heard upon auscultation. The abdomen of the client is normal in appearance and functioning. patients cough. to neuromuscular impairment.

visible.The color of her stool is brown, it is semi formed.When Upper extermities - Inspection and Palpation palpated she doesnt have any tenderness and when light palpation is done muscle guarding is absent. The liver is not palpable. The client has complete upper extremities with normal findings. Lesions The client cannot resist force when asked to resist. She has a are present. Right side functioning is altered due

skin lesion in her right hand and to neuromuscular some scars on her left hand. Lower Extremities - Inspection and Palpation The peripheral pulses are equal. Lymph nodes are not palpable. The IV site is in her left arm. Lack of sensation is present on her right arm. She has edema on both hands and graded as 2+. The client has complete lower extremities. They have normal skin color, texture, moisture without The client cannot resist force when asked to resist. She doesnt have any deformity. The peripheral pulses are equal. Lympnodes are non-palpable. No lesions are observed and the client is still unable to ambulate. Bth feet have edma present and graded as 2+. any edema, lesions and varicosities. Functioning is altered on the right side due to neuromuscular impairment. impairment.

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GORDONS TYPOLOGY
HEALTH PATTERN Health Perception/ Health Management Pattern BEFORE AFTER INTERPRETATION

HOSPITALIZATION HOSPITALIZATION Upon asking, the patient nodded that she didnt follow doctors prescription and advices regarding her health status. The patient and her family had perceived the importance of proper caring for her health since she was admitted. Health was given importance after realization of clients status upon hospitalization. She understands and develop awareness on her health condition and needs to be teaches more about her health condition.

Nutritional Metabolic Pattern

The patient usually eat foods that is high in cholesterol but since she was diagnosed of being hypertensive she gradually avoided this kind of foods.

Since hospitalization, the patient is on soft diet and IVF of PNSS for rehydration and nutritional requirements.

There is a change in eating pattern of the patient; she is restricted to take salty and fatty foods and she need to have a good eating pattern and a choice of a good food that will sustain her 13

nutritional needs. Elimination Pattern The client have a good elimination pattern in terms of her stool and urine. Since the patient was hospitalized, she experience difficulty in fecal elimination. She defecate every other day. She has an indwelling catheter attach to the urine bag. The client has a catheter attached to urine bag, she tends to urinate more often during hospitalization than before , due to the medications given to her. But her metabolic process undergoes changes because of decrease activity due to her condition. ActivityExercise Pattern Upon asking the patiet if she has any activity, the patient nodded yes and sign walking when The patinet nodded yes upon asking if she was assisted by her daughter in doing The patient experiences huge changes on her activity and exercise for she was now depending on her daughter. Thus, significant others play a great role on helping the patient cope up on her health condition.

asked what activity and simple exercise like exrcise she is doing. This has connection with her work as a eatery vendor. flexion and extension of her extremeties.

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Sleep-Rest Pattern

The patient lack enough sleep and rest. It is because of her work that she needs to sleep late at night and woke up early. When asked what time she ususally sleeps, the patient show her both hands which signifies 10pm. When asked on what time she usually woke up, she sign 4am.

Since the patient was hospitalized, she has increase time to sleep and take a rest to sustain her needs.

The patient did not sustain enough sleep and rest periods because of her work. Whe she was hospitalized, she got more time to sleep and rest.

Cognitive Perceptual Pattern

The patient is aware on her health condition. Thus she know very well what might happen but because her family is unable to provide financial assistance to provide enough care, she has no choice but to ignore

She realizes the importance of her health condition when she was hospitalized. With her family,

The patient is aware on her health condition and didnt follow doctors advice and prescription. Thus, her disease progresses, which when she seek advice from health care professionals. Therefore, she realizes

15

this.

the importance of maintaining health lifestyle.

RoleRelationship Pattern

The client said that the relationship of their family members are good, sometimes she was caring for her daughters son.

Since the client was admitted in the hospital, she is dependent on her daughter, husband and sometimes to the other family members.The family became her source of strenght while recovering on her disease.

She had a good supportive family which she needed on her situation now. It is also needed that her family should adapt to changes in the role and responsibilities of the patient..

Value- Belief Pattern

The patient was a Roman Catholic and she usually go to church every Sunday. She also said that there

Since the patient was admitted in hospital she cant go to church thats why she said that she was prayed before

The clients values and beliefs become stronger after hospitalization and it influence how active a

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are times when she cant attend mass when she is feeling sick or weak. Sexuality/ Reproduction Pattern The client said that she was not sexually active because of her age.

starting the day and before sleeping.

role is.

Since the client was admitted to the hospital she was not sexually active because of her condition.

The client was not sexually active anymore.

Coping/Stress tolerance

The patient said that when she had a problem she doesnt told it to anyone of the member of the family instead as a coping mechanism she usually eats barbeque.

Because of her condition right now the patient can talk to her daughter of what she feels for her illness.

The patient eats barbeque whenever she feels stressed to compensate for such stressful moments before hospitalization. But during hospitalization she always talk to her daughter because of her condition

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REVIEW OF SYSTEMS

General

The client nodded, implying Oo when she was asked if nahihirapan siyang gumalaw at magsalita dala ng kanyang karamdaman.

The client gained weight and experienced weakness in the right part of her body.

Skin

The client has edema on the hands and on both feet with a grade of 2+.

Head, Eyes, Ears, Nose, Throat Head: The client nodded her head, implying Oo when she (HEENT) was asked if she was experiencing headache.

Eyes: The client nodded, implying Oo when she was asked if she has blurring of vision and if her eyes are painful.

Ears: The client shook her head, implying Hindi when she was asked if there is painful sensation in her ears. The clients has a good hearing because she can respond to the question upon interviewing but she cant speak normally. She has a slurred speech because of her condition.

Nose: The client doesnt experienced colds but she usually experienced itching in her nostril because of her NGT.

Throat: The client had cough.

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Respiratory

The client nodded, implying Oo when she was asked if she had cough. Wheezing sound was heard upon auscultation.

Cardiovascular

The client nodded, implying Oo when she was asked if she experiences chest pain.

The client has NGT because of her condition, she cant used Gastrointestinal her mouth to chew and has difficulty chewing and swallowing. Genitourinary The client has a foley catheter and have a normal urine output and color as monitored in the urine bag. The client shook her head, implying Hindi when she was Musculoskeletal asked if her body joints are painful when her body is moved.. The client experiences weakness on her right part of the body. The client is sometimes not oriented on time but is able to Neurologic identify the person she is talking to and the place where she is. Hematologic The client shook her head, implying Hindi when she was asked if she experiencing any bleeding (nose, gums).

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ANATOMY AND PHYSIOLOGY

Nervous System

The nervous system is the body's information gatherer, storage center and control system. Its overall functions are to collect information about the body's external/internal states and transfer this information to the brain (afferent system), to analyze this information, and to send impulses out (efferent system) to initiate appropriate motor responses to meet the body's needs.

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The system is composed of specialized cells, termed nerve cells or neurons that communicate with each other and with other cells in the body. A neuron has three parts: 1. the cell body, containing the nucleus 2. dendrites, hair-like structures surrounding the cell body, which conduct incoming signals. 3. the axon (or nerve fiber), varying in length from a millimeter to a meter, which conduct outgoing signals emitted by the neuron. Axons are encased in a fat-like sheath, called myelin, which acts like an insulator and, along with the Nodes of Ranvier, speeds impulse transmission. Typically a given neuron is connected to many thousands of neurons. The specific point of contact between the axon of one cell and a dendrite of another is called a synapse. Messages passed to and from the brain take the form of electrical impulses, or action potentials, produced by a chemical change that progresses along the axon. At the synapse, the impulse causes the release of neurotransmitters (like acetylcholine or dopamine) and this, in turn, drives the impulse to the next neuron. These impulses travel very fast along these chain of neurons -- up to 250 miles per hour. This contrasts with other systems, such as the endocrine system, which may take many hours to respond with hormones. The nerve cell bodies are generally located in groups. Within the brain and spinal cord, the collections of neurons are called nuclei and constitute the gray matter, so-called because of their color. Outside the brain and spinal cord the groups are called ganglia. The remaining areas of the nervous system are tracts of axons, the white matter, so-called because of white myelin sheath. Tracts carrying information of a specific type, such as pain or vision, generally have specific names. . Major Divisions of the Nervous System The nerves of the body are organized into two major systems:
y y

the central nervous system (CNS), consisting of of the brain and spinal cord, the peripheral nervous system (PNS), the vast network of spinal and cranial nerves linking the body to the brain and spinal cord. The PNS is subdivided into:

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1. the autonomic nervous system (involuntary control of internal organs, blood vessels, smooth and cardiac muscles), consisting of the sympathetic NS and parasympathetic NS 2. the somatic nervous system (voluntary control of skin, bones, joints, and skeletal muscle). The two systems function together, with nerves from the periphery entering and becoming part of the central nervous system, and vice versa. Brain Structures

The brain, the body's "control central," is one of the largest of adult organs, consisting of over 100 billion neurons and weighing about 3 pounds. It is typically divided into four parts: the cerebrum, the cerebellum, the diencephalon (thalamus, hypothalamus, sometimes classed as cerebral structures) and the brain stem(medulla oblongata, pons, midbrain), which is an extension of the spinal cord. Cerebrum The largest division of the brain, the cerebrum, consists of two sides, the right and left cerebral hemispheres, which are interconnected by the corpus callosum. The two hemispheres are "twins," each with centers for receiving sensory (afferent) information and for intiating motor (efferent) responses. The left side sends and receives information

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to/from the right side of the body, and vice versa. Various intellectual functions are concentrated in either the left or right hemispheres. The hemispheres are covered by a thin layer of gray matter known as the cerebral cortex. The interior portion consists of white matter, tracts, and nuclei (gray matter) where synapses occur. Each hemisphere of the cerebral cortex is divided into four "lobes" by various sulci and gyri: The sulci (or fissures) are the grooves and the gyri are the "bumps" on the brain's surface.

The four lobes perform specific functions: a) Frontal - controls fine movements (Betz cells)/ upper motor neuron) and smell. Also, center for abstract thinking, judgment, and language (left hemisphere) b) Parietal - coordinates afferent information dealing with pain, temperature, form, shape, texture, pressure, and position. Some memory functions are also found here. c) Temporal - handles dreams, memory, and emotions. Center for auditory function. d) Occipital - governs vision In addition to the four lobes, is the basal ganglia. The basal ganglia aggregates of neurons (gray matter), constitute the extrapyramidal system. The extrapyramidal system governs postural adjustment and gross voluntary movements, as opposed to fine movements, controlled by the frontal lobe. The basal ganglia receive afferent input from the cerebral cortex and thalamus. Their axons synapse in the brain stem and the spinal cord. Cerebellum The cerebellum, the second largest brain structure, sits below the cerebrum. Like the cerebrum, the cerebellum has an outer cortex of gray matter and two hemispheres. It

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receives/relays information via the brain stem. The cerebellum performs 3 major functions, all of which have to do with skeletal-muscle control: Function summary:
y y y

Balance/ Equilibrium of the trunk Muscle tension, spinal nerve reflexes, posture and balance of the limbs Fine motor control, eye movement. (Incoming information is transferred from the cerebral cortex via the pons. Outgoing information goes back to the cortex via the thalamus.)

Cerebellar disease (abscess, hemorrhage, tumors, and trauma) results in ataxia (muscle incoordination), tremors, and disturbances of gait and equilibrium. This can also interfere with a person's ability to talk, eat, and perform other self care tasks. Paralysis does not result from loss of cerebellar function. Diencephalon The diencephalon, located between the cerebrum and the midbrain, consists of several important structures, two of which are the:
y

Thalamus: large, bilateral (right thalamus/left thalamus) egg-shaped mass of gray matter serving as the main synaptic relay center. Receives/relays sensory information to/from the cerebral cortex, including pain/pleasure centers.

Hypothalamus: a collection of ganglia located below the thalamus and associated with the pituitary gland. It has a variety of functions: senses changes in body temperature; controls autonomic activities and hence regulates the sympathetic and parasympathetic nervous systems; links to the endocrine system/controls the pituitary gland; regulates appetite; functions as part of the arousal or alerting mechanism; and links the mind (emotions) to the body -- sometimes, unfortunately, to the degree of producing "psychosomatic disease."

Brain-Stem The medulla oblongata, pons, and midbrain (mesencephalon or cerebral peduncles) -- often referred to collectively as the brain stem -- control the most basic life functions. Of these three, the medulla is the most important. In fact, so vital is the medulla to survival that diseases or injuries affecting it often prove fatal. All functions of the brain stem are associated with cranial nerves III-XII. 24

Function summary:
y y y y

Breathing/respiration (pons, medulla) Heart rate/ action (medulla) Blood pressure (vasoconstriction)/ blood vessel diameter (medulla) Reflex centers for pupillary reflexes and eye movements (midbrain, pons); and for vomiting, coughing, sneezing, swallowing, and hiccupping (medulla).

Blood supply An intricate arterial structure supplies the brain with oxygen-rich blood. At the brain stem, two vertebral arteries, entering through the first cervical vertebrae, join to form the basilar artery. The basilar artery along with two internal carotid arteries, entering through holes at the base of the skull, interconnect at the Circle of Willis. From there, the anterior and middlecerebral arteries arise; the posterior cerebral artery arises from the basilar system. Cranial Nerves There are 12 pairs of cranial nerves. Some bring information from the sense organs to the brain; some control muscles; others are connected to glands or internal organs.

Cranial Nerves I. Olfactory II. Optic III. Occulomotor IV. Trochlear

Major Function Smell Vision Eyelid and eyeball movement Innervates superior oblique turns eye downward and laterally

V. Trigeminal VI. Abducens VII. Facial

Chewing face & mouth touch & pain Turns eye laterally Controls most facial expressions secretion of tears & saliva taste

VIII. Vestibulocochlear

Hearing equilibrium sensation 25

IX. Glossopharyngeal X. Vagus

Taste senses carotid blood pressure Senses aortic blood pressure slows heart rate stimulates digestive organs taste

XI. Spinal Accessory

Controls trapezius & sternocleidomastoid, controls swallowing movements

XII. Hypoglossal

Controls tongue movements

Pathophysiology
Precipitating Factors: - Hypertension BP: 200/140 mmHg Predisposing Factors: - Life style (sedentary) - Age : 53 years old - Diet :Salty and fatty foods

Atherosclerosis

Formation of Plaque deposits

Thrombosis

Hypertension

Occlusion in major vessel

Vascular wall becomes weakened and fragile

Rupture of the affected blood vessel

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CT Scan y Acute Intraparenchymal hemorrahage Mass of blood forms and grows Vasospasm of tissue and arteries Sx:, headache, Unconsciousness, visual disturbances

Bloodseeps into the ventricles

Formation of small and large clots

Sx: dizziness, confusion, headache

CEREBRAL HYPOPERFUSION

Impaired distribution of oxygen and glucose

Tissue hypoxia and cellular starvation Lodges unto other cerebral arteries

Cerebral Ischemia

Initiation of ischemic cascade

Anaerobic metabolism by mitochondria

Production of oxygen free radicals and other reactive oxygen species

Generates large amounts of lactic acid MetabolicAcidosis

Failure production of adenosine triphosphatase Failure of energy dependent process (ion pumping) Release of excitatory neurotransmitter glutamate Influx of calcium Damage to the blood vessel endothelium

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Failure of Activates enzymes that mitochondria digest cell proteins, lipids and nuclear material Brain sustains an irreversible cerebral damage Further energy depletion Release of metalloprotrease (zinc and calcium-dependent enzymes) Break down of collagen, hyaluronic acid and other elements of connective tissue Structural integrity loss of brain tissue and blood vessels Breakdown of the protective Blood Brain Barrier

Cerebral edema Vascular Congestion Compression of tissue Impairedperfusion and function S/Sx: Contralateral hemiparesis, Middle Cerebral Artery Lateral hemisphere, frontal, parietal and temporal lobes, basal ganglia unilateral neglect, altered consciousnes, vision changes, aphasia, memory deficits, headache, 28 slurry speech

Laboratory and Diagnostic Procedures

I. Computed Tomography (CT) Scan

Scan: There is an acute hemorrhage measuring about 3.1 x 4.3 x 3.8 cm (volume of about 26 cc) predominantly involving the right thalamucapsuloganglionic region with perilesional edema and intraventricular dissection. There is an associated compressive effect to the right lateral ventricle with leftward midline shift of about 0.4 cm. The left lateral ventricle and temporal horns are dilated. There is likewise some effacement of the underlying sulci. Incidental note of mucous retention cyst in the right maxillary sinus. Impression: Acute hemorrhage predominantly involving the right thalamucapsuloganglionic region with intraventricular dissection for the associated and other findings, please see body of the report.

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II. Hematology Date: Nov. 26, 2010

Components Hemoglobin Count Hematocrit WBC count Segmenters Lymphocyte Eosinopril Monocyte Stab Basophil Platelets

Result 13.5 0.41 14.2 85 15

Normal Values 12-14g/dl 0.37-0.47   

60-70% 30-40% 1-3% 2-8% 2-6% 0-1%

363

130-400x 10 9

ANALYSIS:

Increased white blood cells indicatemore disease-fighting cells in her body and increased expectedwhen body is fighting off an infection.

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III. Urinalysis Macroscopic Physical Characteristics Color: yellow Transparency: slightly turbid Microscopic Pus Cell: many Red Cell : 1-4 Epithelial Cell: moderate Mucus Thread: 0 Amorphous Urate: few Chemical Albumin: + Sugar: Specific Gravity: 1.020 pH: 5

ANALYSIS:

All values profound to normal results. The color amber yellow is ideal and the slightly turbid transparency is also a normal finding. The microscopic results suggest no significant changes and alterations to its normal values.

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