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.


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

Author Question: Does a Stroke Signal a Monitor Alarm?

Holly Asks:

When a patient is in the ICU being monitored, are there warning signals (ie beeping noises from machines to alert, etc) right before or after a person has a stroke? In other words, can it come on suddenly and how does the nurse know it’s happening or has happened?

Jordyn Says:

This is a great question. What exactly can a monitor do and not do for a nurse?

When I was still in nursing school, I did an internship in an adult ICU. At first, I would go running to every alarm and, often times, the nurses would stay at the station and analyze what was happening. Then, I never went into the patient’s room and one day– all the nurses went running to help a patient suffering a lethal rhythm. Discerning what is and is not a patient emergency is a learning curve for every healthcare provider and the monitor should be a tool in the toolbox and not the ultimate decision maker.

Generally, when a patient is admitted to the ICU, they are placed on cardiac monitoring. This generally includes an ECG (the heart rhythm), the placement of the chest leads will provide a rough count of breathing (through movement of the chest wall as detected by the leads) and oxygen level (which is the lighted probe placed to a finger.)

These are the basics.

All ICU monitoring systems have a tiered alarm system. Meaning, each heart arrhythmia (and other things) are not treated with the same severity. For instance, a heart rate that falls outside the preset parameters may cause the monitor to signal a repetitive single beep or other tone. A good example of this in pediatrics might be a kid whose heart rate increases due to fever and speeds up outside the preset zone.

When a patient goes into a lethal rhythm, like v-fib, v-tach or asystole, the monitor will triple tone.

A stroke is a brain event. Either bleeding, a clot or ischemia causes the patient to lose certain neurological functions that may include speech, and function of a limb. ONLY if these symptoms were precipitated by other vital sign changes (perhaps a drop in oxygen level due to poor breathing) would the monitor alarm. A stroke may not present with a lethal heart arrhythmia. I think a patient would have to signal a nurse that they are experiencing these symptoms or the nurse may discover the patient has suffered a stroke at a scheduled assessment.

However, if the patient is seizing as a result of the stroke, this could cause the monitor to alarm. The seizure motion shakes the leads and it can resemble v-fib on the monitor even though the patient may still be in a normal rhythm but the monitor doesn’t know the difference so it will alarm. 

So, I would say it is possible for a patient to suffer a stroke without the monitor alarming.


 Holly Michael has been published in various national magazines, local newspapers, and in Guideposts books. She also worked as a journalist and features writer. Recently, she signed a contract with Harvest House for a devotional book she’s writing with her son, a type one diabetic in the NFL. Holly lives in Kansas City with her husband, who is an Anglican Bishop. She blogs at Visit her author page at

Author Question: Car Accidents, Head Injuries and Strokes Oh My!

Holly asks:

Got a question. Ok….let me try to make this simple. Charlie sees a doctor for some dizzy spells about a month prior to his accident, but doesn’t go for further tests. He needs orthopedic surgery for broken bones after the accident. Would they do the surgery?

Jordyn: I don’t see this as a big reason NOT to do the surgery. Dizzy spells are pretty non-specific meaning LOTS of things benign (like I have extra fluid in one ear) to major (I have a brain tumor) can cause this. Most often times it is something very benign and transitory.  
Holly: And if he hit his head when his truck rolled over, would he HAVE to have a head injury?
Jordyn: No, he wouldn’t have to have a head injury in the sense that he wouldn’t have to have concussion. He likely would have some bruising and pain at the site of impact but head injury is denoted more by global headache (my whole head hurts and not just the bump), loss of consciousness, nausea/vomiting, confusion, and perhaps amnesia progressing to more serious things if you choose.  

Holly: I’m setting up a scenario where the insurance wants to deny coverage because of a pre-existing condition. (the dizzy spells maybe caused a stroke, or so they determine.)
Jordyn: I don’t think a complaint of dizzy spells would be enough for this. It’s not really a pre-existing condition. A pre-existing condition has to be an actual medical diagnosis and dizziness is a symptom—something only the patient can tell us they experience. A symptom is not something we can measure. So, if he had a diagnosis of TIAs or Transient Ischemic Attacks and one of his symptoms was dizziness then this might be more believable.
Holly: Which gives me a new question. Can you prove a stroke has happened? Or a mini stroke.
Jordyn: Yes, strokes (new and old) can appear on certain imaging tests. MRI is more specific for old and new brain injuries caused by stroke.