Spine’s Arterial Supply is from the Vertebrals and branches of the Thoracic & Abd aorta called ___ arteries.
Radicular arteries
Stroke mgmt
NPO, resolving any issues regarding carotid atheroclerosis, or A Fib (as these are the 2 most common causes)
___: you discovered someone had a stroke overnight. It could have happened in the last 10 hours.
Wake Up Stroke
NIH Stroke Score has how many questions?
What’s the professor’s beef with this?
11 questions. Not enough questions about speech.
The main sx of Carotid dissection is: (3)
syncope, hemiparesis, or coma
Triad of Horner Syndrome
ptosis
miosis
anhydrosis
ptosis, miosis, and anhydrosis are the key triad to diagonose:___ aka ___
Horner Syndrome
oculosympathetic palsy
__ is caused by an abnormality or lesion to the sympathetic chain. The congenital variety is most commonly the result of birth trauma. Acquired cases may occur in children who have had cardiothoracic surgery, trauma, or brainstem vascular malformation. Most worrisome is a Horner syndrome caused by neuroblastoma of the sympathetic chain in the apical lung region
Horner Syndrome
Horner Syndrome is caused by an abnormality of lesion in the ____
Sympathetic chain.
With Horner Syndrome, The congenital variety is most commonly the result of ___
birth trauma
Acquired cases of Horner Syndrome may occur in children who have had (3)
cardiothoracic surgery, trauma, or brainstem vascular malformation
Most worrisome is a Horner syndrome caused by ___ of the sympathetic chain in the apical lung region
Neuroblastoma
____ is a process of progressive demyelination and disintegration of distal axonal segment following neuronal damage
Wallerian degeneration
What can cause Wallerian degeneration? (5)
cerebral infarction, hemorrhage, trauma, necrosis, and focal demyelination.
10 groups that get aneurysms
Smokers HTN Minority are genetic(Marfan, Ehers-Danlos, Osler-Weber-Rendu, Klippel-Trenaunay-Weber) Pts. with polycystic kidney dz. Cocaine users fibromuscular dysplasia Moyamoya dz Cerebral AVM SLE granulomatous angiitis
incidental aneurysms <__ are not likely to rupture
< 7mm
*Most common cause of sub arachnoid hemorrhage
Trauma
The initial bleed of a SAH is called:
sentinel hemorrhage
Top 3 locations of aneurysms (in circle of willis)
30% Anterior Communicating Artery
25% Posterior Communicating Artery
20% Middle Cerebral Artery
Imaging for SAH.
Why is __ better than __?
If this imaging test doesn’t confirm the SAH, what else can you do?
A CT scan (preferably with a CT angiography) should be performed immediately to confirm that hemorrhage has occurred and to search for clues regarding its source.
It is preferable to MRI because it is faster and more sensitive in detecting hemorrhage in the first 24 hours.
CT findings sometimes are normal in patients with suspected hemorrhage, and the cerebrospinal fluid must then be examined for the presence of blood or xanthochromia before the possibility of subarachnoid hemorrhage is discounted.
Most common CT of aneurysmal SAH looks like:
There is a star shape of white, where blood has spilled into the brain.
____ is the occurrence of a vitreous hemorrhage of the human eye in association with subarachnoid hemorrhage
Terson’s syndrome
Who knows what the mechanism for ocular hemorrhage (of Terson’s Syndrome/SAH) is?
The increased ICP affects the eyes, can cause papilledema, blindness.
Clipping and Coiling procedures for aneurysms
Clipping: clips off the ballooned area of the vessel
Coiling: the ballooned area is filled in so nothing else can spill into it.
A safer drug to give for seizurs in the ICU
Keppra aka Levetiracetam
Seizure patients:
Keep Hgb __-__ g/dL (>7 for asymptomatic pts, and >10 for symptomatic vasospasm
8-10 g/dL
Short course of ___ begun @ dx and continued until aneurysm/SAH is secured
antifibrinolytic therapy (Amicar or tranexamic acid)
Noncontrast CT scan reveals a hyperdense clot which has an irregular border with the brain and causes more horizontal displacement (mass effect) than might be expected from its thickness. The disproportionate mass effect is the result of the large rostral-caudal extent of these hematomas
SUBDURAL HEMATOMA
Noncontrast CT scan reveals The tightly attached dura is stripped from the inner table of the skull, producing a characteristic lenticular-shaped hemorrhage.
epidural hematoma
Epidural hematoma’s are usually caused by tearing of the __ artery following fracture of the __ bone.
middle meningeal artery
temporal bone
head CT shows bleeding within the brain matter, not around the perimeter:
Parenchymal hemorrhage