A&V: 34 Cerebrovascular Disease | 837-877

Question 1

Prognosis of ICH (5) ?

Answer 1

1) >30 ml = 35 % mortality n 1-30 days
2) FUNC score and ICH Score are useful for prediction
3) Prompt drainage of ventricles when indicated
4) Location, Size and extension into the ventricles have poor prognosis
5) Healed Scars are epileptogenic

Question 2

Definite treatment strategies for large hemorrhages/comatose state (3)

Answer 2

1) Hyperventilate to 25-30 mmHg CO2 and elevate head of bed
2) Mannitol 1st line Barbituate 2nd line with Na 145-150 (always NS)
3) Normothermia

Question 3

Potential/Controversial treatment strategies for large hemorrhages/comatose state

Answer 3

1) Hydrocephalus = VP shunt
2) Hematoma in young/cortical location 30ml = evacuation as life saving procedure
3) Intraventricular tPA
4) Monitoring ICP (61-80)

Question 4

When to restart AC s/p Hemorrhage ?

Answer 4

1) Definite indication for AC such as prosthetic heart valve = 2 weeks
2) Earlier than 2-6 months creates increased increased for re-hemorrhaging.

Question 5

Definite treatment strategies for large hemorrhages/comatose state (4-7)

Answer 5

4) Glucose 140-180
5) Intermittent Pneumatic Compression
6) GCS