Cerebral Vascular Death - “Stroke”
The Case:
An Ada County Deputy Coroner responded to a local hospital after being notified of the death of a female in her fifties. The patient had expired in less than 24 hours after admission. All patients that expire (even natural deaths) in less than 24 hours after admission to the hospital, are reviewed by the Coroner's Office.
Arriving at Intensive Care Unit, the Deputy was given information from the nursing supervisor that the patient had been brought to the hospital via Life Flight after suffering a witnessed collapse at her residence. According to the witness, she was in the bathroom getting ready for work when she suddenly lost consciousness and collapsed on the floor. The witness called 911 and EMS responded - finding her unresponsive but still alive. They tranported her to a local hospital for treatment. A CT scan was performed which revealed an extensive Subarachonoid Hemorrhage. The patient was then transported by Life Flight to Boise for more advanced care. A second CT was performed which showed that the hemorrhage had increased in size since the first CT. Because of the grave prognosis, the attending physician spoke with family members who made the decision to initiate a DNR/DNI (do not resuscitate/do not intubate) status and provide comfort care only. The patient expired shortly after. She had an extensive medical history which included uncontrolled Hypertension (high blood pressure) and Alcoholism. The doctor signed the death certificate with cause being: Cerebral Vascular Accident and manner being: Natural.
Ischemic strokes involve arterial or vessel blockage. The following are two types of ischemic strokes:
Cerebral Embolism – This type of stroke is the most common of the three types. The carotid arteries serve as the major roadway for blood traveling to the brain. A stroke will occur if any smaller tributaries are occluded, thereby blocking the passage of blood. This can happen if cholesterol, a clot, or other material deposited in a vessel – usually within the carotid artery - breaks off into a smaller vessel where it becomes lodged between the vessel walls. A traveling clot or piece of debris traveling from elsewhere in the body to the brain is called an embolus. When blood supply is cut off from the brain, there is a very serious risk of brain damage and/or death.- Cerebral Thrombosis – The carotid artery in the neck and the cerebral artery in the brain can also succumb to a blood clot or atherosclerosis. When this happens, the occlusion is called a thrombus, a stationary blockage of the artery that cuts off blood passage. TIA, transient ischemic attacks, which may cause stroke-related symptoms last just a short time. If this occurs, you should make immediate plans to see a doctor as TIAs are strong indicators that a stroke is imminent.
Hemorrhagic (bleeding) Stroke is highly fatal as it involves the instantaneous rupture of a blood vessel in the brain.
Intracerebral Hemorrhage – When a vessel inside the brain ruptures, it spills blood into the surrounding area. The effect of vessel rupture is two-fold: the spilled blood irritates brain tissue causing inflammation and swelling and the broken vessel cuts continuous blood flow to the rest of the brain. Causes of this type of stroke include drug and alcohol abuse as well as hypertension. Hypertension, or high blood pressure, puts excess pressure in the brain’s blood vessels thereby causing the walls to weaken. The risk for this stroke increases with age and is found to be higher in the African-American population. This is because more African-Americans have hypertension than any other group in the United States. This is frequently seen in young women and is congenital in nature.- Subarachnoid Hemorrhage – An aneurysm is a weakened part of a vessel wall that may become so thin that it causes a bulge in the wall. If the aneurysms breaks or bursts, a subarachnid hemorrhage will occur. This is a rupture, or trauma causing rupture in a certain area between coverings.
Cerebral Vascular Death - “Stroke”
The Case:
An Ada County Deputy Coroner responded to a local hospital after being notified of the death of a female in her fifties. The patient had expired in less than 24 hours after admission. All patients that expire (even natural deaths) in less than 24 hours after admission to the hospital, are reviewed by the Coroner's Office.
Arriving at Intensive Care Unit, the Deputy was given information from the nursing supervisor that the patient had been brought to the hospital via Life Flight after suffering a witnessed collapse at her residence. According to the witness, she was in the bathroom getting ready for work when she suddenly lost consciousness and collapsed on the floor. The witness called 911 and EMS responded - finding her unresponsive but still alive. They tranported her to a local hospital for treatment. A CT scan was performed which revealed an extensive Subarachonoid Hemorrhage. The patient was then transported by Life Flight to Boise for more advanced care. A second CT was performed which showed that the hemorrhage had increased in size since the first CT. Because of the grave prognosis, the attending physician spoke with family members who made the decision to initiate a DNR/DNI (do not resuscitate/do not intubate) status and provide comfort care only. The patient expired shortly after. She had an extensive medical history which included uncontrolled Hypertension (high blood pressure) and Alcoholism. The doctor signed the death certificate with cause being: Cerebral Vascular Accident and manner being: Natural.
Ischemic strokes involve arterial or vessel blockage. The following are two types of ischemic strokes:
- Cerebral Embolism – This type of stroke is the most common of the three types. The carotid arteries serve as the major roadway for blood traveling to the brain. A stroke will occur if any smaller tributaries are occluded, thereby blocking the passage of blood. This can happen if cholesterol, a clot, or other material deposited in a vessel – usually within the carotid artery - breaks off into a smaller vessel where it becomes lodged between the vessel walls. A traveling clot or piece of debris traveling from elsewhere in the body to the brain is called an embolus. When blood supply is cut off from the brain, there is a very serious risk of brain damage and/or death.
- Cerebral Thrombosis – The carotid artery in the neck and the cerebral artery in the brain can also succumb to a blood clot or atherosclerosis. When this happens, the occlusion is called a thrombus, a stationary blockage of the artery that cuts off blood passage. TIA, transient ischemic attacks, which may cause stroke-related symptoms last just a short time. If this occurs, you should make immediate plans to see a doctor as TIAs are strong indicators that a stroke is imminent.
Hemorrhagic (bleeding) Stroke is highly fatal as it involves the instantaneous rupture of a blood vessel in the brain.
- Intracerebral Hemorrhage – When a vessel inside the brain ruptures, it spills blood into the surrounding area. The effect of vessel rupture is two-fold: the spilled blood irritates brain tissue causing inflammation and swelling and the broken vessel cuts continuous blood flow to the rest of the brain. Causes of this type of stroke include drug and alcohol abuse as well as hypertension. Hypertension, or high blood pressure, puts excess pressure in the brain’s blood vessels thereby causing the walls to weaken. The risk for this stroke increases with age and is found to be higher in the African-American population. This is because more African-Americans have hypertension than any other group in the United States. This is frequently seen in young women and is congenital in nature.
- Subarachnoid Hemorrhage – An aneurysm is a weakened part of a vessel wall that may become so thin that it causes a bulge in the wall. If the aneurysms breaks or bursts, a subarachnid hemorrhage will occur. This is a rupture, or trauma causing rupture in a certain area between coverings.