3. Scenario Mrs. X in her 70’s was admitted in a hospital for vertigo and double vision where it was diagnosed as aneurism in the sub arachnoid space in the brain. She was admitted in a public hospital for the coiling of an aneurysm formed in her brain. During the coiling of the aneurysm a brakes spilling blood into the brain resulting in right sided haemorrhage which eventually caused left sided weakness. Patient was transferred in to this hospital for the rehabilitation after the Stroke

4. Previous Medical History Chole cystectomy Mitral Valve Stenosis Bilateral cataract surgery Diverticulosis Vertigo Left Total Knee Replacement

5. Aetiology and Patho physiology An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel Risk Factors Diabetes Obesity Hypertension Tobacco use Alcoholism High Cholesterol Hereditary Vitamin B12 Deficiency Age

6. Aetiology and Pathophysiology

7. Clipping: A neurosurgeon can operate on the brain by cutting open the skull, identifying the damaged blood vessel and putting a clip across the aneurysm. This prevents blood from entering the aneurysm and causing further growth or blood leakage.

8. Aetiology and Pathophysiology Coiling: A neurosurgeon or interventional radiologist can thread a tube through the arteries, as with an angiogram, identify the aneurysm, and fill it with coils of platinum wire or with latex. This prevents further blood from entering the aneurysm and resolves the problem.

9. Aetiology and Pathophysiology

12. Clinical Manifestations Left sided weakness Nerve palsy Decreased speech clarity Loss of appetite Altered cognition

13. Medications Phenyltoin (500) Od Nocte Clopidogral (75) OD mane Heparin 5000 s/c BD TED stockings Omeprazole Aspirin (150) OD mane

14. Investigations Vitamin B12 Haematology Phenyltoin INR

15. Nursing Management Assistance in managing ADL Maintain the Skin Integrity Management of thrombolytic therapy Nutritional management Management of Pain Psychological support Physiotherapy

16. Let Me Conclude

17. References Lewis,S.,Brown,D.,Edwards,H.,Heitkemper,M., M.,Busher,L.,O’Brien,P.,G.,& Dirksen,S.,R.(2008).Assessment and management of clinical problems. Medical surgical nursing.Ed.2 nd.Elsevier Australia