421 ICH Flashcards
True or false. Compared to ischemic stroke, patients with intracranial hemorrhage are more likely are more likely to present with headache.
True.
True or false. Hemorrhage are classified by their location and the underlying vascular pathology
True.
Generally the preferred method for acute stroke evaluation
CT imaging
Target SBP in intracranial hemorrhage
Less than SBP 140 mmhg
Target cerebral perfusion pressure
50- 70 mmHg; MAP minus ICP
Agents used to lower the blood pressure in ICH
nonvasodilating IV drugs such as nicardipine, labetalol or esmolol
Other principal aspects of initial emergency management
reversal of coagulopathy and consideration of surgical evaluation
most common cause of ICH
hypertension, coagulopathy, sympathomimetic drugs (cocaine and methamphetamine), and cerebral amyloid angiopathy
Most common site of hypertensive ICH
basal ganglia (esp putamen), thalamus, cerebellum and pons
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
True.
Most common site for hypertensive hemorrhage
putamen
where does the eyes deviate in ICH
eyes deviate away from the side of hemiparesis
sentinel sign in ICH
contralateral hemiparesis
In hemorrhage into the thalamus, when is aphasia with preserved repetition is observed
hemorrhage into the dominant hemisphere
in hemorrhage into the thalamus, when is constructional apraxia or mutism observed
hemorrhage into nondominant hemisphere
How does thalamic hemorrhages produce contralateral hemiplagia or hemiparesis
from pressure on or dissection into the adjacent internal capsule
how does thalamic hemorrhages produce ocular disturbances
extension inferiorly into the upper midbrain
chronic contralateral pain syndrome
Dejerine Roussy syndrome
hemorrhage into this area results in deep coma with quadriplegia occuring over a few minutes
pontine hemorrhage
prominent manifestation
prominent decerebrate rigidity and pinpoint 1 mm pupils that react to light
True or false. pontine hemorrhage can develop locked-in state
True.
what is the manifestation of cerebellar hemorrhage
characterized by occipital headache, repeated vomiting, and ataxia of gait
True or false. There is paresis of conjugate gaze towards the side of the hemorrhage, ipsilateral sixth nerve palsy
True.
True or false. If deep cerebellar nuclei are spared, full recovery is common
True.
Major neurologic deficit in occipital hemorrhage
hemianopsia
Neurologic deficit in left temporal hemorrhage
aphasia and delirium
neurologic deficit in parietal hemorrhage
hemisensory loss
neurologic deficit in frontal hemorrhage
arm weakness
disease of the elderly in which arteriolar degeneration occurs and amyloid is deposited in the walls of the cerebral ateries
cerebral amyloid angiopathy (CAA)
most common cause of lobar hemorrhage in the elderly
CAA
True or false. Amyloid angiopathy causes both single and recurrent lobar hemorrhae
True
Most definitive method of diagnosis of CAA
cerebral biopsy
Frequent cause of stroke in the young age less than 45 years old
cocaine and methamphetamine
what the mechanism of sympathomimetic drugs leading to ICH
cocaine enhances sympathetic activity causing acute sometimes severe hypertension leading to hemorrhage
Characteristic intracranial hemorrhage associated with anticoagulant therapy
often lobar or subdural
Characteristic of ICH associated with hematologic disorders
present as multiple ICHs
True or false. Hemorrhage into a brain tumor may be the first manifestation of neoplasm
True.
most common metastatic tumors associated with ICH
choriocarcinoma, malignant melanoma, renal cell carcinoma, and bronchogenic carcinoma
complication of malignant hypertension manifesting as headache, nausea, vomiting, convulsions, confusion, stupor and coma
hypertensive encephalopathy
what is the MRI finding of hypertensive encephalopathy
typical posterior (occipital more than frontal) edema that is reversible and also called as reversible posterior leukoencephalopathy
True or false. Primary intraventricular hemorrhage is rare and can be die to underlying vascular anomaly
True.
why is it hard to identify pontine or medullary hemorrhage
cannot be well delineated because of motion and bone induced artifact that obscure structures in the posterior fossa
Causes of intracranial hemorrhage. Intraparenchymal: frontal lobes, subarachnoid
head trauma
Causes of intracranial hemorrhage. Putamen, globus pallidus, thalamus, cerebellar hemisphere, pons
hypertensive hemorrhage
Causes of intracranial hemorrhage. Basal ganglion, subcortical regions, lobar
Transformation of prior ischemic infarction
Causes of intracranial hemorrhage. Lobar
metastatic, amyloid angiopathy
Causes of intracranial hemorrhage. Any area
coagulopathy
Causes of intracranial hemorrhage. Brainstem
capillary telangiectasias
monoclonal antibody reverses dabigatran
idarucimumab
True or false. In patients with cerebellar hemorrhage, a neurosurgeon should be consulted immediately to assist with the evaluation
True.
diameter of cerebellar hematomas requiring surgical evaluation
cerebellar hematoma more than 3 cm
What to do if cerebellar hematoma is less than 1 cm
surgical referral not necessary
what to do if cerebellar hematoma is 1-3 cm
observant management then surgical referral is condition deteriorates
differentiate SAH from ruptured aneurysm from AVM
in AVM, blood ruptured is not deposited in the basal cistern
large AVM are located in which area
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
Strong influence the risk of AVM rupture
history of prior rupture
hemorrhage rate of unruptured AVM
2-4% per year
hemorrhage rate of previously ruptured AVM
17% a year at least for the first year
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
True.
True or false. Headache in AVMs are not as explosives as in aneurysmal rupture
True.
Congenital shunts between arterial and venous systems that consists of tangle of abnormal vessels across the cortical surface or deep within the brain structure
arteriovenous malformation
result of development of anomalous cerebral, cerebellar, or brainstem venous drainage systems; functional venous channels
venous anomalies
true capillary malformations that often form extensive vascular networks through an otherwise normal brain structure
capillary telangiectasias
typical locations of capillary telangiectasias
pons and deep cerebral white matter
True or false. There is no treatment option exists for capillary telangiectasis. Bleeding rarely produces mass effect
True.
tufts of capillary sinusoids that form within the deep hemispheric white matter and brainstem with no normal intervening neural structures
cavernous angiomas
What is the typical size of cavernous angiomas and anomaly is often associated with
cavernous angiomas are typically less than 1 cm in diameter and often associated with a venous anomaly
acquired connections usually from a dural artery to a dural sinus
dural arteriovenous fistulas
complaint associated with dural arteriovenous fistula
pulse synchronous cephalic bruit or pulsatile tinnitus
curative therapies for dural arteriovenous fistulas
surgical and endovascular techniques
causes of dural arteriovenous fistulas
trauma or idiopathic
true or false. There is an association between fistulas and dural sinus thrombosis
True.
