ICH - Neuro medi Flashcards
(28 cards)
Subarachnoid hemorrhages normally occur in what age?
mean onset is mid-50s
Epidural hemorrhage is usually rupture of what artery?
middle meningeal artery
What is usually post traumatic s/p fall in elderly pt causing rupture of bridging veins?
subdural hemorrhage
Intraparenchymal hemorrhage is a/w
HTN or tumor
Subarachnoid hemorrhage is a/w
trauma or aneurysm
head trauma with brief LOC, lucid interval, then obtunded state; HA
On exam this pt has CL hemiparesis and ipsilateral pupil dialtion (anisocoria).
dx?
epidural hematoma
How would you treat a subdural hematoma?
burr holes and drain if progressively worsening
What does the FUNC score do?
When is it supposed to be used?
estimates the likelihood of functional independence 90 days after a diagnosis of ICH
used when the dx of ICH is made
Score of 0-4 on the FUNC scale means
will have independence at 90 days out
With scoring systems for brain traumas, what is one thing none of them do?
No score determines what you should do next
A subarachnoid hemorrhage on imaging will show what classically?
star shape
Who has a 5x increased risk of hemorrhagic stroke?
hypertensive vasculopathy pt
What is the MC non-traumatic cause of lobar ICH in elderly?
cerebral amyloid angiopathy
How much does smoking increase risk of ICH?
1.5 to 2.5x
a midline shift means altered thalami, which probably means..
altered consciousness
What is the common site of primary brain hemorrhage? What are ssx of disease here?
basal ganglia
CL hemiparesis, sensory loss, CL conjugate gaze paresis
Most unruptured aneurysms are found where?
anterior circulation
What aneurysm location has the highest risk of rupturing?
posterior or PCOM
What presents with ‘worst headache ever’
SAH
What is the Hunt Hess Grade?
Clinical survival scale
- Grade 1
- asymptomatic
- grade 2
- moderate to severe HA, nuchal rigidity, no neuro deficit except CN palsy
- grade 3
- drowsy, minimal neuro deficit
- grade 4
- stuporous, moderate to severe hemiparesis, possible early decerebrate rigidity and vegetative disturbances
- grade 5
- deep coma, decerebrate, moribund
What is the radiographic spasm risk scale?
Modified Fisher Scale
- MC complication of SAH is vasospasm (7-10 days sp)
- predicted by severity of blood on scan
- TCDs screen daily for vasospasm
SAH is mostly diagnosed in the first 12 hours via CT, but if CT is negative, how can I dx SAH?
LP - presence of xanthochromia on CSF - nondiluting blood
absent after 14 days
How do I treat SAH?
prevent re-bleeding (highest risk first 6 hours)
prevent vasospasm using nimodipine in all pts
endovascular coiling> surgical clipping of ruptured aneurysm
MAINTAIN EUVOLEMIA
What three things can I fix to prevent poor outcome in my critical care brain injury pt?
fever, anemia, and hyperglycemia
