(27B) Hemorrhagic Stroke Flashcards
most common cause of a SAH
rupture of berry or saccular aneurysm
what size berry aneurysm is likely to bleed
50% that are 2-5 mm will and many > 5mm
what is the etiology of berry aneurysms?
developmental defect in blood vessel wall
are berry aneurysms more like like in anterior or posterior circulation?
anterior (85%) > posterior (15%)
what genetic diseases predispose someone to SAH
marfans and polycystic kidney disease
risk factors for SAH
stimulant drugs (cocaine) OCPs tobacco and ETOH HTN LOW cholesterol
Signs and symptoms of SAH
SYMPTOMS:
headache ("worst of life")
neck stiffness/pain
photo or phonophobia
N/V
**Focal neuro signs may be ABSENT**
SIGNS:
elevated BO it arrhythmias
retinal hemorrhages
what causes the pain, photo or phonophobia in an SAH
RBCs lyse and breakdown products irritate the meninges
what causes the elevated BP and arrhythmias in SAH
RBC lyse and products irritate the brainste, center that regulates HR
most imp test to reveal SAH or bleeding in brain
CT
*gold std = 4-vessel digital subtraction arterography
When do you get an LP when you suspect SAH? Why?
3-4 hrs after onset of headache–bc you want to allow enough time for the RBCs to lyse and have time for our tests to detect the Hgb
with a LP, how can your differentiate a SAH from just nicking a vein?
IMMEDIATELY spin down–RBC breakdown products vs actual RBCs
treatment for SAH
interventional radiology to coil or clip aneurism
3 most common causes for parenchymal hemorrhages from most to least common
trauma > HTN > AVM
What are Charcot Bouchard aneurysms? What causes them?
micro aneurysms caused by HTN
