hemorrhagic stroke Flashcards
(47 cards)
What percentage of strokes are caused by intracerebral hemorrhage?
10%
It is the second leading cause after ischemic strokes.
What are some risk factors for intracerebral hemorrhage?
- HTN
- Alcohol
- Age
- Smoking
- Illicit drugs
- Tumor
- Cerebral amyloid angiopathy
- Vascular malformation
- Coagulopathies
- Anticoagulation treatment
These factors increase the likelihood of hemorrhage.
What is the most common cause of intracerebral hemorrhage?
Hypertension
It primarily affects deep white matter regions such as BG, BS, thalamus, cerebellum, and pons.
What is hyaline arteriosclerosis also known as?
Lipohyalinosis
It contributes to the development of intracerebral hemorrhage.
What are Charcot-Bouchard microaneurysms associated with?
Intracerebral hemorrhage
These microaneurysms are small dilations of the small penetrating arteries.
What type of hemorrhage is associated with cerebral amyloid angiopathy?
Lobar hemorrhage
This condition is related to Alzheimer’s disease.
What is a significant risk factor related to cerebral amyloid angiopathy?
B-amyloid and apo E mutation
E4 allele is a risk factor, while E2 allele is protective.
What symptoms may present in a patient with intracerebral hemorrhage?
- Focal motor/sensory deficit
- Progressive worsening of symptoms
- Loss of consciousness
- Features of increased ICP
- Seizures
Symptoms can escalate as the hematoma expands.
What is the immediate imaging requirement for suspected intracerebral hemorrhage?
Non-contrast CT
This is mandatory for diagnosis.
What is the most important step in the treatment of intracerebral hemorrhage?
Control hypertension
Target systolic blood pressure should be between 140-160 mmHg.
What medications can be used for IV infusion to control hypertension in intracerebral hemorrhage?
- Labetalol
- Nicardipine (CCB)
These medications should be monitored during administration.
What methods can be used to decrease intracranial pressure (ICP)?
- Elevating head of bed
- Hyperventilation
- Mannitol
Hyperventilation is the fastest way to decrease ICP.
What should be administered for seizures in the case of intracerebral hemorrhage?
IV anti-epileptics
This is part of the management protocol.
What surgical intervention may be necessary in cases of large bleed, coma, brainstem compression, or hydrocephalus?
Neurosurgery
This is considered if conservative management fails.
What is recommended for VTE prophylaxis in intracerebral hemorrhage patients?
IPC (Intermittent Pneumatic Compression)
This helps prevent venous thromboembolism.
What percentage of strokes does subarachnoid hemorrhage (SAH) account for?
5%
SAH is the third cause of strokes.
What is the most common cause of subarachnoid hemorrhage?
Head injury (traumatic SAH)
In the absence of trauma, spontaneous SAH may occur.
What percentage of spontaneous SAH cases is due to the rupture of saccular berry aneurysms?
70%
Most commonly occurs at the Circle of Willis.
What are the common locations for saccular berry aneurysms?
- Anterior communicating artery
- Origin of the posterior communicating artery
These are common branching points.
What are some risk factors for the rupture of aneurysms?
- Smoking
- Family history
- Hypertension
- Alcohol
- Drugs
These factors increase the risk of aneurysm rupture.
What percentage of spontaneous SAH cases is due to congenital arteriovenous malformations (AVM)?
10%
AVMs are a lesser-known cause of SAH.
What is the risk of a first bleed in spontaneous SAH per year?
2-3%
The risk of rebleed is higher at 10% per year.
What are some other causes of subarachnoid hemorrhage besides aneurysm rupture?
- Pituitary apoplexy
- Arterial dissection
- Mycotic (infective) aneurysm
These are less common causes of SAH.
What is the typical presentation of subarachnoid hemorrhage?
- Abrupt onset of severe headache
- Meningeal irritation (neck stiffness, Kernig sign)
- Nausea and vomiting
- Sub-hyaloid hemorrhage
Headache is often described as the worst ever experienced.
