Flashcards in Aneurysms and hemorrhage Deck (18):
What are saccular/berry aneurysms? Where do they occur?
aneurysms that occur at bifurcations in the circle of willis. most common is the junction of the ACA and the AComm.
What are some complications of berry aneurysms?
rupture that causes subarachnoid hemorrage. "worst headache of my life."
can also cause hemorrhagic stroke.
Saccular aneurysms can cause bitemporal heminaopia if they compress the optic chiasm.
(if at PComm, berry aneurysms can cause CNIII palsy)
What conditions are associated with Berry aneurysms?
ADPKD (ausomal dominant polycystic kidney disease), Ehlers-Danlos, Marfan syndrome.
other risks: age, HTN, smoking, Af. Americans.
What is a Charcot-Bouchard microaneurysm?
Associated with chronic HTN. affects the small vessels, esp. the basal ganglia and thalamus.
What is central post-stroke pain syndrome?
neuropathic pain d/t thalamic lesions. initial sensation of numbness and tingling is followed in wks to months by allodynia (ordinary painless stimuli cause pain) and dysaesthesia. seen in 10% of stroke pts.
Epidural hematoma: pathophysiology, clinical scenario, complications.
often rupture of a middle meningeal artery, often secondary to fracture of the temporal bone.
there is a lucid interval with rapid expansion under systemic arterial pressure. This can cause transtentoral herniation (herniation of the cortex to the cerebellar area). It can also cause CN III palsy.
What should I know about appearance of epidural hematomas on CT?
Won't cross suture lines but can cross falx or tentorum. biconvex (lentiform) hyperdense blood.
Subdural hematoma. pathophysiology, clinical scenarios, complications.
caused by a rupture of bridging veins. slow venous bleeding (less pressure means that the hematoma develops over time). seen in elderly ppl, alcoholics, blunt trauma, shaken baby, with predisposing factors like atrophy, shaking, or whip lash.
Appearance of the subdural hematoma on CT?
crescent hemorrhage that can cross suture lines but can't cross falx or tentorum. causes a midline shift.
What is the pathopysiology and clinical scenario of a subarachnoid hemorrhage?
rupture of an aneurysm, like a berry aneurysm, as is seen in Marfan, Ehlers Danlos, or ADPKD (autosomal dominant polycystic kidney disease), or in an AVM. Rapid time course. Pts complain of the "worst headache of my life."
Imaging and complications of a subarachnoid hemorrhage. other tests.
blood in the sulci.
Bloody or yellow spinal tap.
2-3 days afterward, there is a risk of vasospasm d/t blood breakdown, and a risk of rebleed.
How do you treat vasospasm of a subarachnoid hemorrhage?
Intraparenchymal hemorrhage: clinical scenario
most commonly seen with HTN. Also seen with amyloid angiopathy, vasculitis, and neoplasm.
Common locations of intraparenchymal hemorrhage
basal ganglia, internal capsule (related to charcot buchard aneurysms of lenticulostriae vessels). Lobar is possible.
Subfalcine herniation: What is it, and what are some complications?
herniation of the cingulate gyrus under the falx cerebri. may compress the anterior cerebral artery and cause leg weakness and numbness.
Central herniation? what is it, clinical symptoms
aka transtentorial herniation
heriation of the hemispheres down below the tentorum (which goes over the cerebellum). associated with epidural hematoma.
remember that the uncus is the medial temporal lobe. it can compress the ipsilateral CNIII causeing a blown pupil and a down and out eye. it may also compress the ipsilateral posterior cerebral artery, causing occipital probs and contralateral hemonymous hemianopsia. It can also cause compression of the contralateral crus cerebri, which results in paralysis ipsilateral to the herniation (false localizing sign).