intracranial hemorrhage Flashcards Preview

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Flashcards in intracranial hemorrhage Deck (64):
1

intracranial hemorrhage - types

1. epidural hematoma
2. subdural hematoma
3. subarachnoid hemorrhage
4. intraparenchymal (hypertensive) hemorrhage

2

epidural hemorrhage - mechanism

rupture of middle meningeal artery --> rapid expansion (artery)

3

causes of middle meningeal artery rupture

often 2ry to fracture of temporal bone

4

middle meningeal artery is a branch of

maxillary artery

5

epidural hemorrhage - course

- Lucid interval (a temporary improvement in a patient's condition after a traumatic brain injury)
- rapid expansion under systemic arterial pressure

6

epidural hemorrhage - complications

1. transtentorial herniation
2. CN III

7

epidural hematoma - CT

- biconvex (lentiform), hyperdense blood collection
- not crossing suture lines
- can cross falx, tentorium

8

cerebri falx in greek

δρέπανο εγκεφάλου

9

subdural hematoma - mechanism

rupture of bridging veins --> slow venous bleeding
(less pressure because of veins= hematoma develops over time). Can be acute or chronic

10

subdural hematoma is seen in

1. elderly 2. alcoholics 3. blunt trauma 4. shaken baby

11

subdural hematoma - predisposing factors

- brain atrophy
- shaking
- whiplash
- anti-coagulation

12

subdural hematoma - CT

- Crescent-shaped hemorrhage
- crosses sature lines
- Midline shift
- Cannot cross falx, tentorium
- findings of "acute on chronic" haemorrhage
- if acute --> hyperdense, if chronic --> hypodense

13

causes of subarachnoid hemorrhage

1. rupture of an aneurysm (such as berry)
2. arteriovenous malformations

14

Saccular (berry) aneurysm - associations and risk factors

1. ADPKD
2. Ehlers-Danlos syndrome
3. advanced age
4. hypertension
5. smoking
6. race (increased risk with black)

15

subarachnoid hemorrhage - course

rapid course
"worst headache of my life"

16

subarachnoid hemorrhage - spinal tap

blooddy or yellow (xanthochromic)

17

subarachnoid hemorrhage - complications after 4-10 days
(visible on CT)

1. vasospasm due to blood breakdown --> ischemic infract (not visible in CT)
2. rebleed (visible in CT)
3. high risk of developing communicating and/or obstructive hydrocephalus

18

subarachnoid hemorrhage - CT

subarachnoid blood in sulci and intraventricular blood layering in posterior horn of lateral ventricles

19

intraparenchymal (hypertensive) hemorrhage - is caused by

1. hypertension (MCC)
2. amyloid angiopathy
3. vasculitis
4. neoplasm
(can cause Charcot-Bouchard)

20

intraparenchymal (hypertensive) hemorrhage - area

typically occurs in basal ganglia and internal capsule (Charcot-Bouchard aneurysm of leniculostriate vessels)
can be lobar

21

cause of reccurent lobar hemorrhage stroke in elderly

amyloid angiopathy

22

intraparenchymal (hypertensive) hemorrhage - amyloid angiopathy --> (a typical presentation)

recurrent lobar hemorrhagic stroke in elderly

23

Whiplash is a

neck injury due to forceful, rapid back-and-forth movement of the neck, like the cracking of a whip

24

MCC of intraparenchymal (hypertensive) hemorrhage

hypertension

25

aneurysm - definition

an abnormal dilation of artery due to weakening of vessel wall

26

cns aneurysms - types

1. Saccular (berry) aneurysm
2. Charcot-Bouchard microaneurysm

27

Charcot-Bouchard microaneurysm is associated with

chronic hypertension

28

Charcot-Bouchard microaneurysm - area

it affects small vessels (eg. in basal ganglia, thalamus)

29

Charcot-Bouchard microaneurysm - important in diagnosis

not seen in angiogram

30

Saccular (berry) aneurysm - area

bifurcations in the circle of Willis
MC site is junction of anterior communicating artery and anterior cerebral artery

31

Saccular (berry) aneurysm - MC complication

RUPTURE --> subarachnoid hemorrhage or hemorrhagic stroke

32

Saccular (berry) aneurysm - complications

1. rupture (--> subarachnoid hemorrhage or hemorrhagic stroke)
2. bitetemporal hemianopia (via compression of optic chiasm) (anterior comm)
3. visual acuity deficits (anterior comm)
4. CN III palsy (posterior comm)

33

Saccular (berry) aneurysm - race?

increased risk with blacks

34

aneurysm associated with hypertension - saccular or Charcot Bouchard?

both

35

MCC and 2nd MCC of subarachnoid hemorrhage (and proportion)

1. rupture of an aneurysm (such as berry) (80%)
2. arteriovenous malformations (15%)

36

subarachnoid hemorrhage - clinical signs

signs of meningism

37

signs of berry aneyrism (not ruptured)

1. bitemporal hemianopia (anterior comunicating artery)
2. visual acuity defects
3. CN III palsy (posterior comm)

38

subarachnoid hemorrhage induced vasospam - treat with

nimodipine

39

irreversible damage of brain begins after .... of hypoxia (time)

5 min

40

most vulnerable areas of ischemic brain disease (which is the most)

1. hipocampus (MOST) 2. neocortex 3. cerebellum
4. watershed areas

41

in stroke, noncontrast CT is necessary to exclude

hemorrhage (before tPA can be given)

42

images can detect ischemic changes in (time)

1. CT--> 6-24h (but can show almost imminently hemorrhage)
2. diffusion-weighted MRI --> 3-30 min

43

12-48 h after ischemic brain disease disease - histology

red neurons

44

24-72 h after ischemic brain disease disease - histology

necrosis and neutrophils

45

3-5 days after ischemic brain disease disease - histology

macrophages (microglia)

46

1-2 weeks after ischemic brain disease disease - histology

reactive gliosis + vascular proliferation

47

>2 weeks after ischemic brain disease disease - histology

glial scar

48

Hemorrhagic stroke is a

intracerebral bleeding

49

Hemorrhagic stroke is often due to

1. hypertension
2. anticoagulation
3. cancer
4. 2ry to ischemic stroke

50

Hemorrhagic stroke as a result of cancer - mechanism

abnormal vessels can bleed

51

Hemorrhagic stroke 2ry to ischemic stroke

followed by reperfusion (increased vessel fragility)

52

MC side of Hemorrhagic stroke

basal ganglia

53

ischemic stroke - pathophysiology and types

acute blockage of vessels --> disruption of blood flow and subsequent ischemia --> liquefactive necrosis
types: 1. thromotic 2. Embolic 3. hypoxic

54

thrombotic ischemic stroke is due to / MC area

a clot forming directly at site of infarction usually over an atherosclerotic plague. commonly the MCA

55

hypoxic ischemic stroke is due to / area

hypoperfusion or hypoxemia / warershed areas

56

hypoxic ischemic stroke - common during

cardiovascular surgeries

57

embolic ischemic stroke is due to / area

- embolus from another part of the body obstructs vessel
- it can affect multiple vascular territories

58

embolic ischemic stroke - example of causes

1. atrial fibrillation
2. DVT in patent foramen ovale

59

ischemic stroke - treatment

1. tPA 2. Reduce risk with medical therapy
3. optimum control of BP, blood sugar, lipids
4. treat conditions that increase risk (eg. aspirin, clopidogrel)

60

ischemic stroke - treatment - indications for tPA

if within if 3-4,5 h of onset
no hemmorrhage/risk of hemorrhage

61

histologic features of ischemic brain disease (and times)

12-48h --> red neurons
24-72h --> necrosis and neutrophils
3-5h --> macrophages (microglia)
1-2weeks --> reactive gliosis + vascular proliferation
>2weeks --> glial scar

62

transient ischemic attack - definition

Brief, reversible episode of focal neurologic dysfunction without acute infraction (-MRI), with the majority resolving in less than 15 mins

63

transient ischemic attack - due to

temporal focal ischemia

64

transient ischemic attack - permanent damage?

NO