27b - Hemorrhagic Stroke Flashcards
What is the difference between subarachnoid and parenchymal hemorrhage?
bleeding aroudn brain vs bleeding into substance of brain
What are the causes of hemorrhagic stroke?
SAH - 80% due to rupture of berry aneurysm
Parenchymal - trauma, HTN, arteriovenous malformations
What are the risk factors of hemorrhagic stroke?
tobacco, ethanol, HTN, OCs, stimulant drugs, low cholesterol, genetics (polycystic kidney or marfans)
radiologic evaluation of hemorrhagic stroke?
CT, but beware false negatives
What is the use of lumbar puncture in hemorrhagic stroke?
must centrifuge collection immediately.
If clear, blood in fluid was from nicked vein druing puncture.
If still discolored, blood in CSF was from aneurysm and has been there several hours.
Yellow color is from xanthocromia (broken down hemoglobin)
What are the treatment options for subarachnoid hemorrhage?
for berry aneurysm, coil or surgical clipping
How many hemorrhagic strokes are intracerebral compared to subarachnoid?
about 50-50
What is most important diagnostic for hemorrhagic stroke?
CT, but could have false negatives
What diagnostic test besides CT MUST be performed if hemorrhagic stroke is suspected?
lumbar puncture
How big must an aneurysm be for MRI to pick it up?
> 5mm
What is gold standard for hemorrhagic stroke?
4-vessel digital subtraction arteriography (DSA)
What artery is the aneurysm likely in if patient has paraparesis?
anterior cerebral artery aneurysm
What artery is the aneurysm likely in if patient has hemiparesis?
middle cerebral artery aneurysm
What artery is the aneurysm likely in if patient has CN 3 paresis and dilated pupil?
junction of internal carotid and posterior communicating arteries
What role does cholesterol play in hemorrhagic stroke risk?
low cholesterol increases risk of cerebral hemorrhage
Signs and symptoms of subarachnoid hemorrhage?
sudden, severe headache (worst in life)
neck stiffness, Photo and phonophobia
N/V
only minor focal neurologic signs as compared to ischemic stroke
Elevated BP, arrhythmias
What type of hemorrhage would HTN cause? Where is it most likely?
Charcot Bouchard aneurysms that cause parenchymal hemorrhage.
Most common in basal ganglia, thalamus, cerebellum and pons in that order
What are treatment options for parenchymal hemorrhage?
occlusion of AVM with coils.
reduce HTN is charcot bouchard
