advanced pathophysiology neurological section


I completed my two pages paper and would like someone to correct my sentence structure and proofread.  I already used grammarly to correct.  NO need to correct my reference.  The question for the paper is:

” Give an example of the clinical manifestations of a hemorrhagic stroke, based on the anatomy/location of the bleed? Explain why the symptoms would be seen based on the anatomy and physiology. “

This is my paper:


A 62-year-old man has a history of chronic atrial fibrillation and has been taking aspirin daily for the past four years (Runchey & McGee, 2010). While working at his workshop 2 hours earlier, the patient had an abrupt onset of severe headache (Runchey & McGee, 2010). Ten minutes later, the patient had difficulty holding the tools in his left hand and needed assistance to get to the car (Runchey & McGee, 2010). The patient at the emergency department had a new onset of left side weakness, very high blood pressure at 200/108 mmHg, elevated heart rate at 104, a dense left hemiparesis, vomits twice, and positive Babinski responds (Runchey & McGee, 2010). The CT result showed that the patient had cerebral hemorrhage due to leakage of blood into the brain (Runchey & McGee, 2010). The present symptoms of severe headache, vomiting, bilateral Babinski signs, and neck stiffness indicated that the patient had a hemorrhagic stroke (Runchey & McGee, 2010). The study of Ojaghihaghighi, Vahdati, Mikaeilpour, and Ramouz (2017) also pointed out that patients who experienced a hemorrhagic stroke can develop in a few minutes with clinical manifestations including acute onset of headache, vomiting, and severe increase in blood pressure.

Normally, the brain receives blood from two major pairs of arteries, which branch throughout the brain tissue and supply a constant flow of oxygen, glucose, and nutrient to the brain cell for their function (Rink & Khanna, 2011). When a hemorrhagic stroke occurs, it shows an abnormal bleeding abrupt or rupture of the normal blood flow (McCance & Huether, 2019). The bleeding can occur either within the brain or between the brain and the skull (Harvard Health Publishing, 2019). There are two major hemorrhagic strokes include intracerebral hemorrhage and subarachnoid hemorrhage. Intracerebral hemorrhage occurs when there is a broken blood vessel within the brain due to high blood pressure, excessive alcohol use, smoking cigarettes, and the use of cocaine or amphetamines (Harvard Health Publishing, 2019). The most common location is at the bifurcations in or near the circle of Willis (McCance & Huether, 2019). The intracerebral hemorrhage usually happens in a certain part of the brain, such as the basal ganglia, cerebellum, brain stem, or cortex (Rink & Khanna, 2011). With long-standing high blood pressure and a lot of stress on the artery wall, it causes the artery ruptures and start to bleed out of the cerebral circulation (Harvard Health Publishing, 2019). The symptoms can worsen over a period of 30 to 90 minutes, including sudden weakness, inability to speak, vomiting, difficulty walking, and inability to control eye movement (Harvard Health Publishing, 2019). 

For subarachnoid hemorrhage, the bleeding from a damaged blood vessel causes blood to accumulate the brain's surface and fills a portion of the space between the brain and the skull (Harvard Health Publishing, 2019). Patients with head trauma and brain aneurysm are the most common cause of subarachnoid hemorrhage (Cleveland Clinic, 2020). Blood escapes from defective or injured vasculature into the subarachnoid space (McCance & Huether, 2019). The bleeding into the subarachnoid hemorrhagic space due to aneurysm rupture leads to vasospasm and brain ischemia (Zhang, Tao, Feng, & Chen, 2017). When blood flows into the cerebrospinal fluid, it increases the brain's pressure and causes immediate headache. The subarachnoid hemorrhage symptoms include a very severe headache, loss of consciousness, stiff neck, seizure, confusion, nausea and vomiting, and inability to look at a bright light (Harvard Health Publishing, 2019). Therefore, the bleed location, along with the symptoms, indicates the kind of hemorrhagic stroke of a patient.

NOTE: I attached the file, but can't open.  I am not sure why?