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Week 2 (Neuro 2) > Intracranial Hemorrhage > Flashcards

Intracranial Hemorrhage Flashcards

1
Q

how does vasculature guide the hemorrahgic vs intracranial stroke?

A
  • hemorraghic strokes - DO NOT follow vassculature
  • intracranial strokes - FOLLOW vasculature
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2
Q

identify the hemorhages shown in each location

A
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3
Q

list the vasculature most commonly involved in

  • a epidural hemorrhage
  • a subdural hemorrhage
A
  • middle mengineal artery
  • bridging veins
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4
Q

epidural hemorrhage

  • precipiating circumstances
  • vassculature involved
  • clinical presentation
  • exam
  • MRI
  • management
A
  • precipitating event: trauma - often skull fracture
  • vassculature involved: middle meningeal artery
  • clinical: brief LOC -> lucid interval -> obtunded interval -> HA
  • exam: relative to side of injury
    • contralateral hemiparies
    • ipsilateral pupil dilation
  • MRI: bi-convex (lens shape)
  • management: OR
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5
Q

subdural hemorrhage

  • precipitating circumstances
  • vasculature involved
  • clinical presentation
  • MRI
  • management
A
  • preceipiating event: trauma - fall in elderly w/ dementia, alcoholism
  • vasculature involved: bridging veins
  • clinical presentation: HA + altered awarness
  • MRI: narrow, cresent shaped lesion
  • management: situational
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6
Q

intraparenchymal hemorrhage

  • precipitating circumstances
  • clinical presentation
  • MRI
  • management:
A
  • precipitating circumstsances
    • hypertension
    • trauma
  • clinical presentation: progressive HA + vomitting + lethargy
  • MRI: significant mass affect
  • management: monitor, esp posterior fossa
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7
Q

subarachnoid hemorrhage

  • precipitating circumstances
  • clinical presentation
  • MRI
  • management:
A
  • precipitating circumstances:
    • anuerysm rupture - ​ACOM, PCOM*, MCA, PCA
    • trauma
  • clinical presentation: worst HA of life
  • MRI: follows sulci -> can become interventricular
  • management:
    • prevent re-bleed
    • prevent vasospasm
    • endovascular coiling:
      • surgical clipping of ruptured anuerysm, depending on aneurysm size
    • maintaining normal water & salt volumes
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8
Q

which cerebral artery is

  • the mostl likely site for an aneurysm?
  • most likely to rupture d/t an aneurysm?
A
  • anterior circulation (ACOM, ACA) m/c anuerysm site
  • PCOM aneurysm most likely to rupture
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9
Q

what is the purpose of the Hunt Hess Grading Scale?

define each grade

A

predicts survival after an SAH

  • Grade 1: no-minimal HA / slight nuchal ridigity
  • Grade 2: moderate-severe HA / nuchal ridigty but no neurological deficit
  • Grade 3: DROWSY + slight neurological deficit
  • Grade 4: deficit = strupor + hemiparesis
  • Grade 5: deficit = coma
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10
Q

SAH - diagnosis

A
  1. CT scan - senstive up to 12 hrs (most sensitive at 6) post event.
  2. xanthochromia - sensitive 2 hrs - 2 weeks post event. done to r/o false neg CT
  3. CT angiogram - to exclude aneurysm as cause
  4. MRI - to exlude vasculature malformation as a cause
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11
Q

SAH - prevention of re-bleeding:

what is the blood pressure goal?

A

SPB < 160 hrs

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12
Q

SAH - prevention of vasospasm

is done how?

is important why?

A
  • done with CCBs (ex - nimodipine)
  • decreases risk of delayed cerebral ischemia
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13
Q

why is it important to to maintain euvolemia / normonatremia in the management of SAH?

A

to prevent development of hypotonic hyponatremia, a common complication of SAH

if pt develops hypotonic hyponatremia: give hypertonic saline

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14
Q
A
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15
Q

list the common precipitating circumstances for each type of intracranial hemorrhage

A
  • epidural: trauma - often skull fracture
  • subdural: trauma - often a fall, in elderly pt with atrophy / alcoholism
  • subarachnoid: trauma, aneurysm
  • intraparenchyma: tumor, hypertension
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16
Q

list the deficits seen in a primary brain hemorrhage affecting each region:

  • basal ganglia
  • lobar regions
  • thalamus
  • pons
  • cerebellum
A
  • contralateral hemiparesis + sensory loss:
    • basal ganglia: also contralateral conjugate gaze paresis
    • lobar regions: also aphasia, neglect, confusion
    • thalamus: also abnormal eye movements
  • pons:
    • quadriparesis
    • facial weakness
    • miosis
    • decreased consciousness
  • cerebellum:
    • gaze paresis
    • ataxia
    • herniation
    • gaze paresis
    • coma
17
Q

list the common deficits arisng from hemorrhage of the pons

A
  • quadriplegia
  • facial weakness
  • miosis*
  • deceased level of consciousness
18
Q

list the common deficits arising from hemorrhage of the cerebellum

A
  • gaze paresis
  • ataxia
  • hemorrhage
  • coma
19
Q

primary hemorraghe of which brain regions cause contralateral hemiparesis + sensory loss?

inddicate other deficits specific to each region

A
  • thalamus: + abnormal eye movements
  • basal ganglia: + contralateral conjugate gaze paresis
  • lobar regions: +
    • aphasia
    • neglect
    • confusion
20
Q

list the hemorraghic stroke risk factors

A
  • hypertensive vasculopathy
  • cerebral amyloid angiopathy
  • aneurysm / AV malformation
  • women with migraine with aura
  • social
    • excessive EtOH
    • smoking - esp if > 15 in women / > 20 in men
    • cocain / amphetamines
21
Q

what is the biggest risk factor for a hemorraghic stroke?

A

hypertensive vasculopathy

22
Q

other than hypersensive vasculopathy, what is biggest risk factor for a intracranial hemorrhage?

explain

A

cereebral amyloid angiopathy

m/c non-traumatic cause of lobar ICH in the elerly

23
Q

describe the appearance of the eye in a CN III nerve palsy

A

eye is down and out (abducted)

this is b/c the oculomotor nerve adducts & helps elevates

24
Q

explain how to determine the cause a CN III nerve palsy based on the other abormalities present

A
  • pupil dilated: PCOM or tumor
  • pupil spared: intrinsic nerve ischemia (ex- diabetes)
25
Q

how must anti-coagulants be handled in case of a re-bleed following SAH?

A
  • reversed - esp TPA
  • the exception is if the patient requires DVT prophylaxis
26
Q

what are the three major types of cerebral vascular malformations?

A
  • arteriovenous malformation
  • cavernous malformation
  • developmental venous anomaly
27
Q

arteriovenous malformation

  • describe the anatomy
  • clinical presentation?
  • presentation on CT?
  • complications
A
  • anatomy: arteries & veins connected w/out intervening capillary beds - often in temporal lobe
  • clinical presentation: hemorrhage
  • CT scan: calficications
  • complications: can embolize
28
Q

cavernous malformations

  • describe the anatomy
  • clinical presentation?
  • presentation on CT?
A
  • anatomy: vasculature made of endothelial lined caverns d/t defective tight junctions
  • clinical presentation: seizure, brain hemorrhage
  • CT: popcorn/mulberry appearance
29
Q

developmental venous anomaly

  • describe the anatomy
  • clinical presentation
A
  • anatomy: small malformation d/t focal arrest of venous development - sometimes follows intrauterine event
  • clinical presentation: m/c asymptomaic
30
Q

identify

A

arteriovenous malformation - calficiations

31
Q

identify

A

developmental venous anomaly

32
Q

identify

A

cavernous malformation

“popcorn / mulberry appearance” - vascular malformation of endothelial-lined caverns

Week 2 (Neuro 2) (9 decks)

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