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421 ICH Flashcards

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1
Q

True or false. Compared to ischemic stroke, patients with intracranial hemorrhage are more likely are more likely to present with headache.

A

True.

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2
Q

True or false. Hemorrhage are classified by their location and the underlying vascular pathology

A

True.

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3
Q

Generally the preferred method for acute stroke evaluation

A

CT imaging

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4
Q

Target SBP in intracranial hemorrhage

A

Less than SBP 140 mmhg

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5
Q

Target cerebral perfusion pressure

A

50- 70 mmHg; MAP minus ICP

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6
Q

Agents used to lower the blood pressure in ICH

A

nonvasodilating IV drugs such as nicardipine, labetalol or esmolol

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7
Q

Other principal aspects of initial emergency management

A

reversal of coagulopathy and consideration of surgical evaluation

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8
Q

most common cause of ICH

A

hypertension, coagulopathy, sympathomimetic drugs (cocaine and methamphetamine), and cerebral amyloid angiopathy

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9
Q

Most common site of hypertensive ICH

A

basal ganglia (esp putamen), thalamus, cerebellum and pons

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10
Q

True or false. After 1-6 months, the hemorrhage is generally resolved to a slitlike cavity lined with a glial scar and hemosiderin laden macrophages

A

True.

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11
Q

Most common site for hypertensive hemorrhage

A

putamen

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12
Q

where does the eyes deviate in ICH

A

eyes deviate away from the side of hemiparesis

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13
Q

sentinel sign in ICH

A

contralateral hemiparesis

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14
Q

In hemorrhage into the thalamus, when is aphasia with preserved repetition is observed

A

hemorrhage into the dominant hemisphere

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15
Q

in hemorrhage into the thalamus, when is constructional apraxia or mutism observed

A

hemorrhage into nondominant hemisphere

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16
Q

How does thalamic hemorrhages produce contralateral hemiplagia or hemiparesis

A

from pressure on or dissection into the adjacent internal capsule

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17
Q

how does thalamic hemorrhages produce ocular disturbances

A

extension inferiorly into the upper midbrain

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18
Q

chronic contralateral pain syndrome

A

Dejerine Roussy syndrome

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19
Q

hemorrhage into this area results in deep coma with quadriplegia occuring over a few minutes

A

pontine hemorrhage

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20
Q

prominent manifestation

A

prominent decerebrate rigidity and pinpoint 1 mm pupils that react to light

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21
Q

True or false. pontine hemorrhage can develop locked-in state

A

True.

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22
Q

what is the manifestation of cerebellar hemorrhage

A

characterized by occipital headache, repeated vomiting, and ataxia of gait

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23
Q

True or false. There is paresis of conjugate gaze towards the side of the hemorrhage, ipsilateral sixth nerve palsy

A

True.

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24
Q

True or false. If deep cerebellar nuclei are spared, full recovery is common

A

True.

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25
Major neurologic deficit in occipital hemorrhage
hemianopsia
26
Neurologic deficit in left temporal hemorrhage
aphasia and delirium
27
neurologic deficit in parietal hemorrhage
hemisensory loss
28
neurologic deficit in frontal hemorrhage
arm weakness
29
disease of the elderly in which arteriolar degeneration occurs and amyloid is deposited in the walls of the cerebral ateries
cerebral amyloid angiopathy (CAA)
30
most common cause of lobar hemorrhage in the elderly
CAA
31
True or false. Amyloid angiopathy causes both single and recurrent lobar hemorrhae
True
32
Most definitive method of diagnosis of CAA
cerebral biopsy
33
Frequent cause of stroke in the young age less than 45 years old
cocaine and methamphetamine
34
what the mechanism of sympathomimetic drugs leading to ICH
cocaine enhances sympathetic activity causing acute sometimes severe hypertension leading to hemorrhage
35
Characteristic intracranial hemorrhage associated with anticoagulant therapy
often lobar or subdural
36
Characteristic of ICH associated with hematologic disorders
present as multiple ICHs
37
True or false. Hemorrhage into a brain tumor may be the first manifestation of neoplasm
True.
38
most common metastatic tumors associated with ICH
choriocarcinoma, malignant melanoma, renal cell carcinoma, and bronchogenic carcinoma
39
complication of malignant hypertension manifesting as headache, nausea, vomiting, convulsions, confusion, stupor and coma
hypertensive encephalopathy
40
what is the MRI finding of hypertensive encephalopathy
typical posterior (occipital more than frontal) edema that is reversible and also called as reversible posterior leukoencephalopathy
41
True or false. Primary intraventricular hemorrhage is rare and can be die to underlying vascular anomaly
True.
42
why is it hard to identify pontine or medullary hemorrhage
cannot be well delineated because of motion and bone induced artifact that obscure structures in the posterior fossa
43
Causes of intracranial hemorrhage. Intraparenchymal: frontal lobes, subarachnoid
head trauma
44
Causes of intracranial hemorrhage. Putamen, globus pallidus, thalamus, cerebellar hemisphere, pons
hypertensive hemorrhage
45
Causes of intracranial hemorrhage. Basal ganglion, subcortical regions, lobar
Transformation of prior ischemic infarction
46
Causes of intracranial hemorrhage. Lobar
metastatic, amyloid angiopathy
47
Causes of intracranial hemorrhage. Any area
coagulopathy
48
Causes of intracranial hemorrhage. Brainstem
capillary telangiectasias
49
monoclonal antibody reverses dabigatran
idarucimumab
50
True or false. In patients with cerebellar hemorrhage, a neurosurgeon should be consulted immediately to assist with the evaluation
True.
51
diameter of cerebellar hematomas requiring surgical evaluation
cerebellar hematoma more than 3 cm
52
What to do if cerebellar hematoma is less than 1 cm
surgical referral not necessary
53
what to do if cerebellar hematoma is 1-3 cm
observant management then surgical referral is condition deteriorates
54
differentiate SAH from ruptured aneurysm from AVM
in AVM, blood ruptured is not deposited in the basal cistern
55
large AVM are located in which area
largest AVMs are frequently located in the posterior half of the hemispheres, commonly forming a wedge-shaped lesions extending from the cortex to the ventricle
56
Strong influence the risk of AVM rupture
history of prior rupture
57
hemorrhage rate of unruptured AVM
2-4% per year
58
hemorrhage rate of previously ruptured AVM
17% a year at least for the first year
59
True or false. Large AVMs in the anterior circulation may be associated with systolic and diastolic bruit over the eye, forehead, neck or bounding carotid pulse
True.
60
True or false. Headache in AVMs are not as explosives as in aneurysmal rupture
True.
61
Congenital shunts between arterial and venous systems that consists of tangle of abnormal vessels across the cortical surface or deep within the brain structure
arteriovenous malformation
62
result of development of anomalous cerebral, cerebellar, or brainstem venous drainage systems; functional venous channels
venous anomalies
63
true capillary malformations that often form extensive vascular networks through an otherwise normal brain structure
capillary telangiectasias
64
typical locations of capillary telangiectasias
pons and deep cerebral white matter
65
True or false. There is no treatment option exists for capillary telangiectasis. Bleeding rarely produces mass effect
True.
66
tufts of capillary sinusoids that form within the deep hemispheric white matter and brainstem with no normal intervening neural structures
cavernous angiomas
67
What is the typical size of cavernous angiomas and anomaly is often associated with
cavernous angiomas are typically less than 1 cm in diameter and often associated with a venous anomaly
68
acquired connections usually from a dural artery to a dural sinus
dural arteriovenous fistulas
69
complaint associated with dural arteriovenous fistula
pulse synchronous cephalic bruit or pulsatile tinnitus
70
curative therapies for dural arteriovenous fistulas
surgical and endovascular techniques
71
causes of dural arteriovenous fistulas
trauma or idiopathic
72
true or false. There is an association between fistulas and dural sinus thrombosis
True.

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