27b - Hemorrhagic Stroke

Question 1

What is the difference between subarachnoid and parenchymal hemorrhage?

Answer 1

bleeding aroudn brain vs bleeding into substance of brain

Question 2

What are the causes of hemorrhagic stroke?

Answer 2

SAH - 80% due to rupture of berry aneurysm

Parenchymal - trauma, HTN, arteriovenous malformations

Question 3

What are the risk factors of hemorrhagic stroke?

Answer 3

tobacco, ethanol, HTN, OCs, stimulant drugs, low cholesterol, genetics (polycystic kidney or marfans)

Question 4

radiologic evaluation of hemorrhagic stroke?

Answer 4

CT, but beware false negatives

Question 5

What is the use of lumbar puncture in hemorrhagic stroke?

Answer 5

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)

Question 6

What are the treatment options for subarachnoid hemorrhage?

Answer 6

for berry aneurysm, coil or surgical clipping

Question 7

How many hemorrhagic strokes are intracerebral compared to subarachnoid?

Answer 7

about 50-50

Question 8

What is most important diagnostic for hemorrhagic stroke?

Answer 8

CT, but could have false negatives

Question 9

What diagnostic test besides CT MUST be performed if hemorrhagic stroke is suspected?

Answer 9

lumbar puncture

Question 10

How big must an aneurysm be for MRI to pick it up?

Answer 10

> 5mm

Question 11

What is gold standard for hemorrhagic stroke?

Answer 11

4-vessel digital subtraction arteriography (DSA)

Question 12

What artery is the aneurysm likely in if patient has paraparesis?

Answer 12

anterior cerebral artery aneurysm

Question 13

What artery is the aneurysm likely in if patient has hemiparesis?

Answer 13

middle cerebral artery aneurysm

Question 14

What artery is the aneurysm likely in if patient has CN 3 paresis and dilated pupil?

Answer 14

junction of internal carotid and posterior communicating arteries

Question 15

What role does cholesterol play in hemorrhagic stroke risk?

Answer 15

low cholesterol increases risk of cerebral hemorrhage

Question 16

Signs and symptoms of subarachnoid hemorrhage?

Answer 16

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

Question 17

What type of hemorrhage would HTN cause? Where is it most likely?

Answer 17

Charcot Bouchard aneurysms that cause parenchymal hemorrhage.
Most common in basal ganglia, thalamus, cerebellum and pons in that order

Question 18

What are treatment options for parenchymal hemorrhage?

Answer 18

occlusion of AVM with coils.

reduce HTN is charcot bouchard