Hemorrhagic Stroke

Question 1

What is are two debilitating forms of hemorrhagic stroke

Answer 1

Subarachnoid hemorrhage (SAH): Extravastion (leakage) of blood in the subarachnoid space, Intracerebral hemorrhage (ICH): bleeding into the parenchyma

Question 2

What are aneurysms, where do they occur to cause hemorrhagic stroke

Answer 2

weakening of an artery wall that leads to a bulge distention, biforcations of an artery

Question 3

T/F: Most strokes are ischemic and hemmorrhagic stroke occurs only 13% percent of the time. Most hemorrhagic strokes are ICH but SAH is associated with higher mortalities

Answer 3

True

Question 4

What is a difference in cause of SAH compared to ICH

Answer 4

Trauma is cause in SAH while ICH can be caused by a spontaneous small vessel rupture

Question 5

What are causes of hemorrhagic stroke that is common between both types

Answer 5

Rupture of aneurysm, arteriovenous malformations, neoplasm, coagulopathy

Question 6

What are modifiable risk factors acute SAH, ICH

Answer 6

Hypertension, smoking, alcohol abuse, cocaine use/ same while including anticoagulation

Question 7

Whant is used to diagnosis the type of stroke, what identifies the source of the bleeding

Answer 7

Computerized tomography (CT) scan,k cerebral aniography

Question 8

What are the two management options of aSAH

Answer 8

Surgical intervention and medical management

Question 9

When should surgical intervention be done to treat a aSAH, what are they

Answer 9

less than 3 days post-bleed/ crainiotomy for cliiping or percutaneous transluminal aniographic placement of glue

Question 10

What should the blood pressure be before surgical procedure, what agents can be given

Answer 10

Nitroprusside, labetalol, nicardipine

Question 11

What drug is indicated for aSAH, what is the dose and how long is it given

Answer 11

Nimodipine, 60 mg by mouth or nasal gastic tube every 4 hours for 21 days (can be given 30 mg every 2 hours if hypotensive)

Question 12

T/f: Nimodipine is given in aSAH to lower the blood pressure in the brain that caused the aneurysym

Answer 12

False: Nimodipine is given for aSAH because it decreases the neurological deficits associated with vasospasms due to ischemia after aSAH

Question 13

What other therapies should be given to a patient who had aSAH

Answer 13

Stool softner, DVT prophylaxis (Heparin 5000 units BID), antiemetics (N +V drugs), H2RAs and PPIs, fluids to keep the patient euvolemic

Question 14

If a patient comes in with a ICH and they are takeing warfarin what should be given to bind it, when and what should be checked to see if therapy is working

Answer 14

Phytonadione AND KCentra, recheck INR in 30 mins and every 6 to 8 hours for next 24-48 hours

Question 15

What is KCentra contraindicated in

Answer 15

Disseminated intravascular coagulation and Heparin Induced Thrombocytopenia

Question 16

When is the risk of re-hemmorhage greatest

Answer 16

Within the first 6 hours

Question 17

If a patient comes in with a ICH and they are taking dabigatran what should be given to bind it, alternatives

Answer 17

Praxbind (monoclonal antibody fragment), FEIBA or Kcentra

Question 18

If a patient comes in with a ICH and they are taking rivaroxaban/apixaban/edoxaban what should be given to bind it, what are the limitations

Answer 18

Andexanet alfa/ return of anticoagulation effect after infusion,cost

Question 19

What should the blood pressure management be for a patient who has ICH

Answer 19

If SBP is 150-220 mmHg and without contraindication to acute management acute lowering to 140 mm hg is appropiate, greater than 220 aggressive reduction with continous infusion is considered