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Neurology > 421 ICH > Flashcards

421 ICH Flashcards

1
Q

True or false. Compared to ischemic stroke, patients with intracranial hemorrhage are more likely are more likely to present with headache.

A

True.

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2
Q

True or false. Hemorrhage are classified by their location and the underlying vascular pathology

A

True.

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3
Q

Generally the preferred method for acute stroke evaluation

A

CT imaging

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4
Q

Target SBP in intracranial hemorrhage

A

Less than SBP 140 mmhg

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5
Q

Target cerebral perfusion pressure

A

50- 70 mmHg; MAP minus ICP

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6
Q

Agents used to lower the blood pressure in ICH

A

nonvasodilating IV drugs such as nicardipine, labetalol or esmolol

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7
Q

Other principal aspects of initial emergency management

A

reversal of coagulopathy and consideration of surgical evaluation

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8
Q

most common cause of ICH

A

hypertension, coagulopathy, sympathomimetic drugs (cocaine and methamphetamine), and cerebral amyloid angiopathy

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9
Q

Most common site of hypertensive ICH

A

basal ganglia (esp putamen), thalamus, cerebellum and pons

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10
Q

True or false. After 1-6 months, the hemorrhage is generally resolved to a slitlike cavity lined with a glial scar and hemosiderin laden macrophages

A

True.

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11
Q

Most common site for hypertensive hemorrhage

A

putamen

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12
Q

where does the eyes deviate in ICH

A

eyes deviate away from the side of hemiparesis

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13
Q

sentinel sign in ICH

A

contralateral hemiparesis

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14
Q

In hemorrhage into the thalamus, when is aphasia with preserved repetition is observed

A

hemorrhage into the dominant hemisphere

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15
Q

in hemorrhage into the thalamus, when is constructional apraxia or mutism observed

A

hemorrhage into nondominant hemisphere

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16
Q

How does thalamic hemorrhages produce contralateral hemiplagia or hemiparesis

A

from pressure on or dissection into the adjacent internal capsule

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17
Q

how does thalamic hemorrhages produce ocular disturbances

A

extension inferiorly into the upper midbrain

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18
Q

chronic contralateral pain syndrome

A

Dejerine Roussy syndrome

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19
Q

hemorrhage into this area results in deep coma with quadriplegia occuring over a few minutes

A

pontine hemorrhage

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20
Q

prominent manifestation

A

prominent decerebrate rigidity and pinpoint 1 mm pupils that react to light

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21
Q

True or false. pontine hemorrhage can develop locked-in state

A

True.

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22
Q

what is the manifestation of cerebellar hemorrhage

A

characterized by occipital headache, repeated vomiting, and ataxia of gait

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23
Q

True or false. There is paresis of conjugate gaze towards the side of the hemorrhage, ipsilateral sixth nerve palsy

A

True.

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24
Q

True or false. If deep cerebellar nuclei are spared, full recovery is common

A

True.

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25
Q

Major neurologic deficit in occipital hemorrhage

A

hemianopsia

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26
Q

Neurologic deficit in left temporal hemorrhage

A

aphasia and delirium

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27
Q

neurologic deficit in parietal hemorrhage

A

hemisensory loss

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28
Q

neurologic deficit in frontal hemorrhage

A

arm weakness

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29
Q

disease of the elderly in which arteriolar degeneration occurs and amyloid is deposited in the walls of the cerebral ateries

A

cerebral amyloid angiopathy (CAA)

30
Q

most common cause of lobar hemorrhage in the elderly

A

CAA

31
Q

True or false. Amyloid angiopathy causes both single and recurrent lobar hemorrhae

A

True

32
Q

Most definitive method of diagnosis of CAA

A

cerebral biopsy

33
Q

Frequent cause of stroke in the young age less than 45 years old

A

cocaine and methamphetamine

34
Q

what the mechanism of sympathomimetic drugs leading to ICH

A

cocaine enhances sympathetic activity causing acute sometimes severe hypertension leading to hemorrhage

35
Q

Characteristic intracranial hemorrhage associated with anticoagulant therapy

A

often lobar or subdural

36
Q

Characteristic of ICH associated with hematologic disorders

A

present as multiple ICHs

37
Q

True or false. Hemorrhage into a brain tumor may be the first manifestation of neoplasm

A

True.

38
Q

most common metastatic tumors associated with ICH

A

choriocarcinoma, malignant melanoma, renal cell carcinoma, and bronchogenic carcinoma

39
Q

complication of malignant hypertension manifesting as headache, nausea, vomiting, convulsions, confusion, stupor and coma

A

hypertensive encephalopathy

40
Q

what is the MRI finding of hypertensive encephalopathy

A

typical posterior (occipital more than frontal) edema that is reversible and also called as reversible posterior leukoencephalopathy

41
Q

True or false. Primary intraventricular hemorrhage is rare and can be die to underlying vascular anomaly

A

True.

42
Q

why is it hard to identify pontine or medullary hemorrhage

A

cannot be well delineated because of motion and bone induced artifact that obscure structures in the posterior fossa

43
Q

Causes of intracranial hemorrhage. Intraparenchymal: frontal lobes, subarachnoid

A

head trauma

44
Q

Causes of intracranial hemorrhage. Putamen, globus pallidus, thalamus, cerebellar hemisphere, pons

A

hypertensive hemorrhage

45
Q

Causes of intracranial hemorrhage. Basal ganglion, subcortical regions, lobar

A

Transformation of prior ischemic infarction

46
Q

Causes of intracranial hemorrhage. Lobar

A

metastatic, amyloid angiopathy

47
Q

Causes of intracranial hemorrhage. Any area

A

coagulopathy

48
Q

Causes of intracranial hemorrhage. Brainstem

A

capillary telangiectasias

49
Q

monoclonal antibody reverses dabigatran

A

idarucimumab

50
Q

True or false. In patients with cerebellar hemorrhage, a neurosurgeon should be consulted immediately to assist with the evaluation

A

True.

51
Q

diameter of cerebellar hematomas requiring surgical evaluation

A

cerebellar hematoma more than 3 cm

52
Q

What to do if cerebellar hematoma is less than 1 cm

A

surgical referral not necessary

53
Q

what to do if cerebellar hematoma is 1-3 cm

A

observant management then surgical referral is condition deteriorates

54
Q

differentiate SAH from ruptured aneurysm from AVM

A

in AVM, blood ruptured is not deposited in the basal cistern

55
Q

large AVM are located in which area

A

largest AVMs are frequently located in the posterior half of the hemispheres, commonly forming a wedge-shaped lesions extending from the cortex to the ventricle

56
Q

Strong influence the risk of AVM rupture

A

history of prior rupture

57
Q

hemorrhage rate of unruptured AVM

A

2-4% per year

58
Q

hemorrhage rate of previously ruptured AVM

A

17% a year at least for the first year

59
Q

True or false. Large AVMs in the anterior circulation may be associated with systolic and diastolic bruit over the eye, forehead, neck or bounding carotid pulse

A

True.

60
Q

True or false. Headache in AVMs are not as explosives as in aneurysmal rupture

A

True.

61
Q

Congenital shunts between arterial and venous systems that consists of tangle of abnormal vessels across the cortical surface or deep within the brain structure

A

arteriovenous malformation

62
Q

result of development of anomalous cerebral, cerebellar, or brainstem venous drainage systems; functional venous channels

A

venous anomalies

63
Q

true capillary malformations that often form extensive vascular networks through an otherwise normal brain structure

A

capillary telangiectasias

64
Q

typical locations of capillary telangiectasias

A

pons and deep cerebral white matter

65
Q

True or false. There is no treatment option exists for capillary telangiectasis. Bleeding rarely produces mass effect

A

True.

66
Q

tufts of capillary sinusoids that form within the deep hemispheric white matter and brainstem with no normal intervening neural structures

A

cavernous angiomas

67
Q

What is the typical size of cavernous angiomas and anomaly is often associated with

A

cavernous angiomas are typically less than 1 cm in diameter and often associated with a venous anomaly

68
Q

acquired connections usually from a dural artery to a dural sinus

A

dural arteriovenous fistulas

69
Q

complaint associated with dural arteriovenous fistula

A

pulse synchronous cephalic bruit or pulsatile tinnitus

70
Q

curative therapies for dural arteriovenous fistulas

A

surgical and endovascular techniques

71
Q

causes of dural arteriovenous fistulas

A

trauma or idiopathic

72
Q

true or false. There is an association between fistulas and dural sinus thrombosis

A

True.

Neurology (14 decks)

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