Vascular Events- Brain bleeds, LPs Flashcards
MC location of a berry aneurysm
Anterior communicating artery
Two dz associated with berry (sacular) aneurysm
- Autosomal dominant polycystic kidney dz
2. Ehlers-Danlos (NOT marfan)
MCC of subarachnoid hemorrhage?
Trauma
MCC of subarachnoid hem if not trauma? what is 2nd?
- Ruptured aneurysm
2. ruptured AVM (arteriovenous malformation)
Worst headache of life
subarachnoid hemorrhage
workup for “worst HA of life”?
- non contrast CT (look for blood)
2. LP (look for blood again)
what is xanthanchromia, what does it indicate?
Yellowish coloration to CSF due to bilirubin (heme breakdown); indicative of a chronic subarachnoid hemorrhage (if bilirubin present, blood has been there for a while)
medical tx for subarachnoid hemorrhage?
Nimodipine–> dihydropyridine CCB; helps prevent vasospasm, which occurs often after a subarach. bleed
Sx tx for subarachnoid bleed?
Surgical clip
lucid interval
epidural hematoma
crescent-shaped on CT
subdural hematoma
Charcot-bouchard microaneurysm–> where and what is likely cause?
small lenticulostriate vessels supplying basal ganglia and thalamus, or internal capsule–> HTN MCC
(can also be due to amyloid angiopathy, vasculitis, neoplasm, cocaine, or anticoagulant theapy)
pt wakes up fro sleepinf with stroke symptoms due to thrombosis… candidate for tPA?
NO–> only if presents within 4.5 hours; must assume they had it right when went to sleep
old person hits their head and present 3 days later with severe headache and vomiting
subdural hematoma–> common in alcoholics too due to cerebral atrophy
*What 8 structures (in order) are passed during an LP
- Skin
- Superficial fascia
- 3 ligaments (Supraspinatus, interspinatus, ligamentum flavum)
- Epidural space
- Dura mater
- Arachnoid space
- Subarachnoid space (where CSF is; where spinal anethesia in given)
