Chapter 40: Caring for Clients with Neurologic Deficits

The primary arthropod vector in North America that transmits encephalitis is the tick. horse. mosquito. flea.

Mosquito

A client is hospitalized with Guillain-Barré syndrome. Which nursing assessment finding is most significant? Warm, dry skin Urine output of 40 ml/hour Soft, nondistended abdomen Uneven, labored respirations

Uneven, labored respirations

A client is status post-CVA with significant residual effects. When did this client begin the recovery phase of the neurologic deficit? upon stabilization at the time of the CVA one day after the CVA upon receiving diagnostic results

Upon stabilization

A 25-year-old female client with brain metastases is considering her life expectancy after her most recent meeting with her oncologist. Based on the fact that the client is not receiving treatment for her brain metastases, what is the nurse's most appropriate action? Promoting the client's functional status and ADLs Ensuring that the client receives adequate palliative care Ensuring that the family does not tell the client that her condition is terminal Promoting adherence to the prescribed medication regimen

Ensuring that the client receives adequate palliative care

A male client presents to the clinic reporting a headache. The nurse notes that the client is guarding his neck and tells the nurse that he has stiffness in the neck area. The nurse suspects the client may have meningitis. What is another well-recognized sign of this infection? Negative Brudzinski sign Positive Kernig sign Hyperpatellar reflex Sluggish pupil reaction

Positive Kernig sign

A patient has been diagnosed with meningococcal meningitis at a community living home. When should prophylactic therapy begin for those who have had close contact with the patient? Within 24 hours after exposure Within 48 hours after exposure Within 72 hours after exposure Therapy is not necessary prophylactically and should only be used if the person develops symptoms.

Within 24 hours after exposure

The clinic nurse caring for a client with Parkinson disease notes that the client has been taking levodopa and carbidopa (Sinemet) for 7 years. For what common side effect should the nurse assess this client? Pruritus Dyskinesia Lactose intolerance Diarrhea

Dyskinesia

The nurse is developing a plan of care for a client newly diagnosed with Bell palsy. The nurse's plan of care should address what characteristic manifestation of this disease? Tinnitus Facial paralysis Pain at the base of the tongue Diplopia

Facial paralysis

The nurse is planning the care of a client who has been recently diagnosed with a cerebellar tumor. Due to the location of this client's tumor, the nurse should implement measures to prevent what complication? Falls Audio hallucinations Respiratory depression Labile BP

Falls

A nurse is providing care to a client who has been diagnosed with metastatic brain cancer. When developing the client's plan of care, which outcome would the nurse most likely identify? Improved quality of life Elimination of distressing signs and symptoms Removal of all or part of the tumor Reduced incidence of recurrence

Improved quality of life

The clinic nurse is caring for a client with a recent diagnosis of myasthenia gravis. The client has begun treatment with pyridostigmine bromide. What change in status would most clearly suggest a therapeutic benefit of this medication? Increased muscle strength Decreased pain Improved GI function Improved cognition

Increased muscle strength

While assessing the client at the beginning of the shift, the nurse inspects a surgical dressing covering the operative site after the clients' cervical discectomy. The nurse notes that the drainage is 75% saturated with serosanguineous discharge. What is the nurse's most appropriate action? Page the health care provider and report this sign of infection. Reinforce the dressing and reassess in 1 to 2 hours. Reposition the client to prevent further hemorrhage. Inform the surgeon of the possibility of a dural leak.

Inform the surgeon of the possibility of a dural leak.

A client has been diagnosed with a frontal lobe brain abscess. Which nursing intervention is appropriate? Assess for facial weakness. Initiate seizure precautions. Assess visual acuity. Ensure that client takes nothing by mouth.

Initiate seizure precautions

The nurse is providing postoperative care for a client who just underwent surgery to remove a metastatic intramedullary tumor. On postoperative day 3, the client states, "I am really looking forward to going running again, it had become too difficult because of the loss of feeling in my feet." Which should the nurse address in the client's care plan? Body image disturbance Anxiety Impaired cognition Knowledge deficit

Knowledge deficit

Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of demyelination in the brain and spinal cord? Parkinson disease Huntington disease Creutzfeldt-Jakob disease Multiple sclerosis

Multiple sclerosis

Which is a chronic, degenerative, progressive disease of the central nervous system characterized by the occurrence of small patches of demyelination in the brain and spinal cord? Parkinson disease Huntington disease Creutzfeldt-Jakob disease Multiple sclerosis

Multiple sclerosis

The nurse caring for a client diagnosed with Parkinson disease has prepared a plan of care that would include what goal? Promoting effective communication Controlling diarrhea Preventing cognitive decline Managing choreiform movements

Promoting effective communication

A client with diabetes presents to the clinic and is diagnosed with a mononeuropathy. This client's nursing care should involve which of the following? Protection of the affected limb from injury Passive and active ROM exercises for the affected limb Education about improvements to glycemic control Interventions to prevent contractures

Protection of the affected limb from injury

The nurse is caring for a patient with Huntington's disease in the long-term care facility. What does the nurse recognize as the most prominent symptom of the disease that the patient exhibits? Rapid, jerky, involuntary movements Slow, shuffling gait Dysphagia and dysphonia Dementia

Rapid, jerky, involuntary movements

A client diagnosed with a malignant brain tumor is scheduled to receive chemotherapy intrathecally. When explaining this technique to the client, the nurse would describe the medication as being injected into which area? Subarachnoid space Central vein Implanted port Epidural space

Subarachnoid space

The nurse is teaching a client with Guillain-Barré syndrome about the disease. The client asks how he can ever recover if demyelination of his nerves is occurring. What would be the nurse's best response? "Guillain-Barré spares the Schwann cell, which allows for remyelination in the recovery phase of the disease." "In Guillain-Barré, Schwann cells replicate themselves before the disease destroys them, so remyelination is possible." "I know you understand that nerve cells do not remyelinate, so the physician is the best one to answer your question." "For some reason, in Guillain-Barré, Schwann cells become activated and take over the remyelination process."

"Guillain-Barré spares the Schwann cell, which allows for remyelination in the recovery phase of the disease."

The nurse has been educating a client newly diagnosed with MS. Which statement by the client indicates an understanding of the education? "I will take hot tub baths to decrease spasms." "I should participate in non-weight-bearing exercises." "I will stretch daily as directed by the physical therapist." "The exercises should be completed quickly to reduce fatigue."

"I will stretch daily as directed by the physical therapist."

The daughter of a patient with Huntington's disease asks the nurse what the risk is of her inheriting the disease. What is the best response by the nurse? "The disease is not hereditary and therefore there is no risk to you." "If one parent has the disorder, there is an 75% chance that you will inherit the disease." "If one parent has the disorder, there is a 50% chance that you will inherit the disease." "The disease is inherited and all offspring of a parent will develop the disease."

"If one parent has the disorder, there is a 50% chance that you will inherit the disease."

Myasthenia gravis occurs when antibodies attack which receptor sites? Serotonin Dopamine Acetylcholine Gamma-aminobutyric acid

Acetylcholine

Clients who have suffered neurologic deficits from various causes, including cerebrovascular accident, closed head injury, etc., have all experienced which phase of neurologic deficit? acute recovery chronic management

Acute

During a Tensilon test to determine if a patient has myasthenia gravis, the patient complains of cramping and becomes diaphoretic. Vital signs are BP 130/78, HR 42, and respiration 18. What intervention should the nurse prepare to do? Place the patient in the supine position. Administer diphenhydramine (Benadryl) for the allergic reaction. Administer atropine to control the side effects of edrophonium. Call the rapid response team because the patient is preparing to arrest.

Administer atropine to control the side effects of edrophonium.

A client with a metastatic brain tumor of the frontal lobe experiences a generalized seizure for the first time. The nurse should prepare for what action? Intubation STAT computed tomography (CT) health care provider A STAT MRI Administration of anticonvulsants

Administration of anticonvulsants

A client diagnosed with Bell palsy is being cared for on an outpatient basis. During health education, the nurse should promote which of the following actions? Applying a protective eye shield at night Chewing on the affected side to prevent unilateral neglect Avoiding the use of analgesics whenever possible Avoiding brushing the teeth

Applying a protective eye shield at night

Which nursing intervention is the priority for a client in myasthenic crisis? Assessing respiratory effort Administering intravenous immunoglobin (IVIG) per orders Preparing for plasmapheresis Ensuring adequate nutritional support

Assessing respiratory effort

A patient is diagnosed with an intracerebral tumor. The nurse knows that the diagnosis may include which of the following? Select all that apply. Astrocytoma Ependymoma Medulloblastoma Meningioma Acoustic neuroma

Astrocytoma Ependymoma Medulloblastoma

The nurse caring for a client in ICU diagnosed with Guillain-Barré syndrome should prioritize monitoring for what potential complication? Impaired skin integrity Cognitive deficits Hemorrhage Autonomic dysfunction

Autonomic dysfunction

A neurologic deficit is best defined as a deficit of the: central and peripheral nervous systems with decreased, impaired, or absent functioning. central nervous system that affects one body system. central nervous system with absent functioning. peripheral nervous system with decreased or impaired functioning.

Central and peripheral nervous systems with decreased, impaired, or absent functioning

A middle-aged woman has sought care from her primary provider and undergone diagnostic testing that has resulted in a diagnosis of MS. What sign or symptom is most likely to have prompted the woman to seek care? Cognitive declines Personality changes Contractures Difficulty in coordination

Difficulty in coordination

A client is being admitted to the neurologic ICU with suspected herpes simplex virus encephalitis. What nursing action best addresses the client's complaints of headache? Initiating a patient-controlled analgesia (PCA) of morphine sulfate Administering hydromorphone IV as needed Dimming the lights and reducing stimulation Distracting the client with activity

Dimming the lights and reducing stimulation

A client with MS has been admitted to the hospital following an acute exacerbation. When planning the client's care, the nurse addresses the need to enhance the client's bladder control. What aspect of nursing care is most likely to meet this goal? Establish a timed voiding schedule. Avoid foods that change the pH of urine. Perform intermittent catheterization q6h. Administer anticholinergic drugs as prescribed.

Establish a timed voiding schedule.

A client with paralysis is disturbed by spontaneous erections. Which nursing action may help the client? Explain that it may occur when the bladder is full. Suggest the use of a disposable porous pad. Perform passive ROM exercise. Recommend medical assistance.

Explain that it may occur when the bladder is full

A client has been admitted to the neurologic unit for the treatment of a newly diagnosed brain tumor. The client has just exhibited seizure activity for the first time. What is the nurse's priority response to this event? Identify the triggers that precipitated the seizure. Implement precautions to ensure the client's safety. Teach the client's family about the relationship between brain tumors and seizure activity. Ensure that the client is housed in a private room.

Implement precautions to ensure the client's safety

A nurse is planning the care of a 28-year-old woman hospitalized with a diagnosis of myasthenia gravis. What approach would be most appropriate for the care and scheduling of diagnostic procedures for this client? All at one time, to provide a longer rest period Before meals, to stimulate her appetite In the morning, with frequent rest periods Before bedtime, to promote rest

In the morning, with frequent rest periods

The nurse is caring for a client with a brain tumor who is experiencing symptoms due to compression and infiltration of normal tissue. The pathophysiologic changes that result can cause what manifestations? Select all that apply. Intracranial hemorrhage Infection of cerebrospinal fluid Increased ICP Focal neurologic signs Altered pituitary function

Increased ICP Focal neurologic signs Altered pituitary function

A 37-year-old man is brought to the clinic by his wife because he is experiencing loss of motor function and sensation. The health care provider suspects the client has a spinal cord tumor and hospitalizes him for diagnostic testing. In light of the need to rule out spinal cord compression from a tumor, the nurse will most likely prepare the client for what test? Anterior-posterior x-ray Ultrasound Lumbar puncture MRI

MRI

A 73-year-old man comes to the clinic complaining of weakness and loss of sensation in his feet and legs. Assessment of the client shows decreased reflexes bilaterally. Why would it be a challenge to diagnose a peripheral neuropathy in this client? Older adults are often vague historians. The elderly have fewer peripheral nerves than younger adults. Many older adults are hesitant to admit that their body is changing. Many symptoms can be the result of normal aging process.

Many symptoms can be the result of normal aging process

The critical care nurse is caring for 25-year-old man admitted to the ICU with a brain abscess. What is a priority nursing responsibility in the care of this client? Maintaining the client's functional independence Providing health education Monitoring neurologic status closely Promoting mobility

Monitoring neurologic status closely

A client with possible bacterial meningitis is admitted to the ICU. What assessment finding would the nurse expect for a client with this diagnosis? Pain upon ankle dorsiflexion of the foot Neck flexion produces flexion of knees and hips Inability to stand with eyes closed and arms extended without swaying Numbness and tingling in the lower extremities

Neck flexion produces flexion of knees and hips

A client with Guillain-Barré syndrome has experienced a sharp decline in vital capacity. What is the nurse's most appropriate action? Administer bronchodilators as ordered. Remind the client of the importance of deep breathing and coughing exercises. Prepare to assist with intubation. Administer supplementary oxygen by nasal cannula.

Prepare to assist with intubation

The critical care nurse is admitting a client in myasthenic crisis to the ICU. The nurse should prioritize what nursing action in the immediate care of this client? Suctioning secretions Facilitating ABG analysis Providing ventilatory assistance Administering tube feedings

Providing ventilatory assistance

The nurse is caring for a client with multiple sclerosis (MS). The client tells the nurse the hardest thing to deal with is the fatigue. When teaching the client how to reduce fatigue, what action should the nurse suggest? Taking a hot bath at least once daily Resting in an air-conditioned room whenever possible Increasing the dose of muscle relaxants Avoiding naps during the day

Resting in an air-conditioned room whenever possible

A patient is diagnosed with a spinal cord tumor and has had a course of radiation and chemotherapy. Two months after the completion of the radiation, the patient complains of severe pain in the back. What is pain an indicator of in a patient with a spinal cord tumor? Lumbar sacral strain The development of a skin ulcer from the radiation Hematoma formation Spinal metastasis

Spinal metastasis

A patient with Bell's palsy says to the nurse, "It doesn't hurt anymore to touch my face. How am I going to get muscle tone back so I don't look like this anymore?" What interventions can the nurse suggest to the patient? Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone. Suggest applying cool compresses on the face several times a day to tighten the muscles. Inform the patient that the muscle function will return as soon as the virus dissipates. Tell the patient to smile every 4 hours.

Suggest massaging the face several times daily, using a gentle upward motion, to maintain muscle tone.

Following a traumatic brain injury, a client has been in a coma for several days. Which of the following statements is true of this client's current LOC? The client occasionally makes incomprehensible sounds. The client's current LOC will likely become a permanent state. The client may occasionally make nonpurposeful movements. The client is incapable of spontaneous respirations.

The client may occasionally make nonpurposeful movements

The nurse is writing a care plan for a client with brain metastases. The nurse decides that an appropriate nursing diagnosis is "anxiety related to lack of control over the health circumstances." In establishing this plan of care for the client, the nurse should include what intervention? The client will receive antianxiety medications every 4 hours. The client's family will be instructed on planning the client's care. The client will be encouraged to verbalize concerns related to the disease and its treatment. The client will begin intensive therapy with the goal of distraction.

The client will be encouraged to verbalize concerns related to the disease and its treatment

A client who has been experiencing numerous episodes of unexplained headaches and vomiting has subsequently been referred for testing to rule out a brain tumor. What characteristic of the client's vomiting is most consistent with a brain tumor? The client's vomiting is accompanied by epistaxis. The client's vomiting does not relieve his nausea. The client's vomiting is unrelated to food intake. The client's emesis is blood-tinged.

The client's vomiting is unrelated to food intake.

A patient with myasthenia gravis is in the hospital for treatment of pneumonia. The patient informs the nurse that it is very important to take pyridostigmine bromide (Mestinon) on time. The nurse gets busy and does not administer the medication until after breakfast. What outcome will the patient have related to this late dose? The muscles will become fatigued and the patient will not be able to chew food or swallow pills. There should not be a problem, since the medication was only delayed by about 2 hours. The patient will go into cardiac arrest. The patient will require a double dose prior to lunch.

The muscles will become fatigued and the patient will not be able to chew food or swallow pills.

A client diagnosed with a pituitary adenoma has arrived on the neurologic unit. When planning the client's care, the nurse should be aware that the effects of the tumor will primarily depend on what variable? Whether the tumor utilizes aerobic or anaerobic respiration The specific hormones secreted by the tumor The client's pre-existing health status Whether the tumor is primary or the result of metastasis

The specific hormones secreted by the tumor

The nurse is assisting with administering a Tensilon test to a patient with ptosis. If the test is positive for myasthenia gravis, what outcome does the nurse know will occur? Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes. After administration of the medication, there will be no change in the status of the ptosis or facial weakness. The patient will have recovery of symptoms for at least 24 hours after the administration of the Tensilon. Eight hours after administration, the acetylcholinesterase begins to regenerate the available acetylcholine and will relieve symptoms.

Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes

A 45-year-old client is admitted to the facility with excruciating paroxysmal facial pain. He reports that the episodes occur most often after feeling cold drafts and drinking cold beverages. Based on these findings, the nurse determines that the client is most likely suffering from which neurologic disorder? Bell's palsy Trigeminal neuralgia Migraine headache Angina pectoris

Trigeminal neuralgia

The nurse is caring for a client diagnosed with Parkinson disease. The client is having increasing problems with rising from the sitting to the standing position. What should the nurse suggest to the client to use that will aid in getting from the sitting to the standing position as well as aid in improving bowel elimination? Use of a bedpan Use of a raised toilet seat Sitting quietly on the toilet every 2 hours Following the outlined bowel program

Use of a raised toilet seat

A client with suspected Parkinson disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor? When the client is resting When the client is ambulating When the client is preparing his or her meal tray to eat When the client is participating in occupational therapy

When the client is resting

A client diagnosed with Bell palsy is having decreased sensitivity to touch of the involved nerve. What should the nurse recommend to prevent atrophy of the muscles? Blowing up balloons Deliberately frowning Smiling repeatedly Whistling

Whistling

A client's spouse relates how the client reported a severe headache and then was unable to talk or move their right arm and leg. After diagnostics are completed and the client is admitted to the hospital, when would basic rehabilitation begin? immediately in 2 to 3 days after 1 week upon transfer to a rehabilitation unit

immediately

After undergoing surgery for removal of a spinal cord tumor, the client is placed in the side-lying position. The nurse places a pillow between the client's knees to prevent: pressure injury. cerebrospinal fluid (CSF) leakage. body misalignment. knee flexion.

knee flexion.

A client's spouse relates how the client reported a severe headache, and shortly after was unable to talk or move their right arm and leg. The spouse indicates the client has hypertension. What should be the focus of management during this phase? preventing further neurologic damage reporting changes to the physician destabilizing client's condition assessing vital signs frequently

preventing further neurologic damage

The nurse is caring for a client newly diagnosed with a primary brain tumor. The client asks the nurse where the tumor came from. What would be the nurse's best response? "Your tumor originated from somewhere outside the CNS." "Your tumor likely started out in one of your glands." "Your tumor originated from cells within your brain itself." "Your tumor is from nerve tissue somewhere in your body."

"Your tumor originated from cells within your brain itself."

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding? Dysphagia Dysphonia Hypokinesia Micrographia

Dysphonia

A patient suspected of having Guillain-Barré syndrome has had a lumbar puncture for cerebrospinal fluid (CSF) evaluation. When reviewing the laboratory results, what does the nurse find that is diagnostic for this disease? Glucose in the CSF Elevated protein levels in the CSF Red blood cells present in the CSF White blood cells in the CSF

Elevated protein levels in the CSF

A client has a neurological defect and will be transferred to a nursing home because family members are unable to care for the client at home. While receiving a bed bath, the client yells at the nurse, "You don't know what you are doing!" What is the best reaction by the nurse? Accept the patient's behavior and do not take it personally. Request that the patient be cared for by another nurse. Discontinue the bath and resume it later. Explain that the client is getting good care.

Accept the patient's behavior and do not take it personally

An older adult has encouraged her husband to visit their primary provider, stating that she is concerned that he may have Parkinson disease. Which of the wife's descriptions of her husband's health and function is most suggestive of Parkinson disease? "Lately he seems to move far more slowly than he ever has in the past." "He often complains that his joints are terribly stiff when he wakes up in the morning." "He's forgotten the names of some people that we've known for years." "He's losing weight even though he has a ravenous appetite."

"Lately he seems to move far more slowly than he ever has in the past."

A client with Parkinson disease is experiencing episodes of constipation that are becoming increasingly frequent and severe. The client states that he has been achieving relief for the past few weeks by using over-the-counter laxatives. How should the nurse respond? "It's important to drink plenty of fluids while you're taking laxatives." "Make sure that you supplement your laxatives with a nutritious diet." "Let's explore other options, because laxatives can have side effects and create dependency." "You should ideally be using herbal remedies rather than medications to promote bowel function."

"Let's explore other options, because laxatives can have side effects and create dependency."

The nurse in an extended care facility is planning the daily activities of a client with post-polio syndrome. The nurse recognizes the client will best benefit from physical therapy when it is scheduled at what time? Immediately after meals In the morning Before bedtime In the early evening

In the morning

A client with Parkinson disease is undergoing a swallowing assessment because she has recently developed adventitious lung sounds. The client's nutritional needs should be met by what method? Total parenteral nutrition (TPN) Provision of a low-residue diet Semisolid food with thick liquids Minced foods and a fluid restriction

Semisolid food with thick liquids

A gerontologic nurse is advocating for diagnostic testing of an 81-year-old client who is experiencing personality changes. The nurse is aware of what factor that is known to affect the diagnosis and treatment of brain tumors in older adults? The effects of brain tumors are often attributed to the cognitive effects of aging. Brain tumors in older adults do not normally produce focal effects. Older adults typically have numerous benign brain tumors by the eighth decade of life. Brain tumors cannot normally be treated in clients over age 75.

The effects of brain tumors are often attributed to the cognitive effects of aging

A client with herpes simplex virus encephalitis (HSV) has been admitted to the ICU. What medication would the nurse expect the health care provider to order for the treatment of this disease process? Cyclosporine Acyclovir Cyclobenzaprine Ampicillin

Acyclovir

A client has just returned to the unit from the PACU after surgery for a tumor within the spine. The client complains of pain. When positioning the client for comfort and to reduce injury to the surgical site, the nurse will position to client in what position? In the high Fowler position In a flat side-lying position In the Trendelenburg position In the reverse Trendelenburg position

In a flat side-lying position

A client, brought to the clinic by his wife and son, is diagnosed with Huntington disease. When providing anticipatory guidance, the nurse should address the future possibility of what effect of Huntington disease? Metastasis Risk for stroke Emotional and personality changes Pathologic bone fractures

Emotional and personality changes

Bell palsy is a disorder of which cranial nerve? Trigeminal (V) Vestibulocochlear (VIII) Facial (VII) Vagus (X)

Facial (VII)

While caring for clients who have suffered neurologic deficits from causes such as cerebrovascular accident and closed head injury, an important nursing goal that motivates nurses to offer the best care possible is preventing: complications. falls. choking. infection.

complications.

A nurse is assessing a client with an acoustic neuroma who has been recently admitted to an oncology unit. What symptoms is the nurse likely to find during the initial assessment? Loss of hearing, tinnitus, and vertigo Loss of vision, change in mental status, and hyperthermia Loss of hearing, increased sodium retention, and hypertension Loss of vision, headache, and tachycardia

Loss of hearing, tinnitus, and vertigo

The nurse teaches the client that corticosteroids will be used to treat his brain tumor to prevent extension of the tumor. facilitate regeneration of neurons. reduce cerebral edema. identify the precise location of the tumor.

Reduce cerebral edema

A client with herpes simplex virus (HSV) encephalitis is receiving acyclovir. To ensure early intervention, the nurse monitors laboratory values and urine output for which type of adverse reactions? Musculoskeletal Integumentary Hepatic Renal

Renal

A nurse is providing care to a client recently diagnosed with a brain tumor. When planning this client's care, the nurse anticipates which therapy as providing the best outcome for the client? Surgery Radiation therapy Chemotherapy Immunotherapy

Surgery

A client is diagnosed with a brain angioma. When teaching the client about the risks associated with this type of brain tumor, the nurse would educate about signs and symptoms associated with which condition? Hemorrhagic stroke Thyroid disorders Hearing loss Visual loss

Hemorrhagic stroke