Brain 4 Flashcards
Management considerations for cerebral vasospasm following subarachnoid hemorrhage include:
a. hematocrit 30%
b. nifedipine
c. nimodipine
d. controlled hypotension
e. mannitol
f. daily transcranial doppler exams
a. hematocrit 30%
c. nimodipine
f. daily transcranial doppler exams
__________ is the leading cause of morbidity and mortality after subarachnoid hemorrhage.
Vasospasm
Most aneurysms arise
in the circle of Willis
The most common cause of subarachnoid bleeding is
aneurysm rupture
______________ predisposes the aneurysm to rupture
Increased transmural pressure
Surgical options for hemorrhagic stroke include
aneurysm clipping or endovascular coiling
Cerebral vasospasm is
a delayed contraction of the cerebral arteries
Cerebral vasospasm can lead to
cerebral infarction and is the most significant source of morbidity and mortality in the patient with SAH
What is the treatment if vasospasm occurs?
triple H therapy (hypervolemia, hypertension, and hemodilution to 27-32%)
_______ is the only calcium channel blocker shown to reduce morbidity and mortality associated with vasospasm
Nimodipine- it does not relieve the spasm but increases collateral blood flow
Arterial bleeding usually occurs in the
subarachnoid space
Venous bleeding usually occurs in the
subdural space
Signs of SAh include
an intense headache that is often described as “the worst headache in my life”
focal neurological deficits
LOC
N/V
photophobia
fever
To reduce the risk of rebleeding, surgical repair of aneurysm should occur
24-48 hours following the initial bleed
If an endovascular coil is placed, the patient will require
heparinization
If the aneurysm ruptures during endovascular coiling,
you should immediately reverse heparin with 1 mg of protamine for every 100 U of heparin administered
MAP should be lowered into the low/normal range
Describe intraoperative blood pressure control for hemorrhagic stroke.
SBP between 120-150 mmHg
if the patient undergoes an open repair, a clamp is commonly placed on a proximal feeder vessel which reduces transmural pressure and the risk of intraoperative rupture while also circumventing the need for controlled hypotension
If a rupture occurs during induction and intubation, the focus of anesthetic management is on
reducing ICP and utilizing methods of cerebral protection
The most common presentation of cerebral vasospasm includes
a new neurologic deficit or altered level of consciousness
The gold standard for diagnosis of cerebral vasospasm is
cerebral angiography
Patients who suffer aneurysmal subarachnoid hemorrhage are at risk for
cerebral salt-wasting syndrome (CSW)
Cerebral salt-wasting syndrome is treated with
isotonic crystalloids
How does cerebral salt-wasting syndrome occur?
the brain releases natriuretic peptide (just like the overfilled heart) and this leads to volume contraction, hyponatremia, and sodium wasting by the kidney
When is cerebral vasospasm most likely to occur?
4-9 days following SAH
