Flashcards in Vascular Events- Brain bleeds, LPs Deck (22):
MC location of a berry aneurysm
Anterior communicating artery
Two dz associated with berry (sacular) aneurysm
1. Autosomal dominant polycystic kidney dz
2. Ehlers-Danlos (NOT marfan)
MCC of subarachnoid hemorrhage?
MCC of subarachnoid hem if not trauma? what is 2nd?
1. Ruptured aneurysm
2. ruptured AVM (arteriovenous malformation)
Worst headache of life
workup for "worst HA of life"?
1. non contrast CT (look for blood)
2. LP (look for blood again)
what is xanthanchromia, what does it indicate?
Yellowish coloration to CSF due to bilirubin (heme breakdown); indicative of a chronic subarachnoid hemorrhage (if bilirubin present, blood has been there for a while)
medical tx for subarachnoid hemorrhage?
Nimodipine--> dihydropyridine CCB; helps prevent vasospasm, which occurs often after a subarach. bleed
Sx tx for subarachnoid bleed?
crescent-shaped on CT
Charcot-bouchard microaneurysm--> where and what is likely cause?
small lenticulostriate vessels supplying basal ganglia and thalamus, or internal capsule--> HTN MCC
(can also be due to amyloid angiopathy, vasculitis, neoplasm, cocaine, or anticoagulant theapy)
pt wakes up fro sleepinf with stroke symptoms due to thrombosis... candidate for tPA?
NO--> only if presents within 4.5 hours; must assume they had it right when went to sleep
old person hits their head and present 3 days later with severe headache and vomiting
subdural hematoma--> common in alcoholics too due to cerebral atrophy
*What 8 structures (in order) are passed during an LP
2. Superficial fascia
3. 3 ligaments (Supraspinatus, interspinatus, ligamentum flavum)
4. Epidural space
5. Dura mater
6. Arachnoid space
7. Subarachnoid space (where CSF is; where spinal anethesia in given)
Where are LPs done
b/n L3-L4 (L3/L4 saves the cord)
*lower in children, because their spinal cord is lower
landmark for doing LP
top of iliac crest is level of L4
difference b/n stroke and TIA?
TIA symptoms resolve in 24 hrs
4 areas most vulnerable to ishemia
4. watershed areas
*watershed b/n MCA/ACA and MCA/PCA distribution; usually better off due to anastomosis in occlusion, but in hypotnesion, first to die
CT reveals what in stroke workup
If hemorrhagic or not
lenticulate or lens shaped (football) on CT