64 Clinical Intracerebral Hemorrhage Flashcards
Terminology
- What is the difference between an intracranial hemorrhage and an intracerebral hemorrhage?
Stroke
- What is the definition of a stroke?
- What percentage of strokes are ischemic?
- What percentage of strokes are hemorrhagic?
- What are the 2 kinds of intraparenchymal hemorrhages?
- What is the most common non-intraparenchymal hemorrhage?
What is shown here?
Typical Locations of Intracerebral hemorrhages
- Hypertensive ICH’s commonly occur in the:
- Putamen
- Thalamus
- Subcortical white matter
- Pons
- and Cerebellum .
- They can also present as lobar hemorrhages.
Which common ICH is shown?
Putamen
Typical Locations of Intracerebral hemorrhages
- Hypertensive ICH’s commonly occur in the:
- Putamen
- Thalamus
- Subcortical white matter
- Pons
- and Cerebellum .
- They can also present as lobar hemorrhages.
Which common ICH is shown?
Thalamus
Typical Locations of Intracerebral hemorrhages
- Hypertensive ICH’s commonly occur in the:
- Putamen
- Thalamus
- Subcortical white matter
- Pons
- and Cerebellum .
- They can also present as lobar hemorrhages.
Which common ICH is shown?
Subcortical white matter
Typical Locations of Intracerebral hemorrhages
- Hypertensive ICH’s commonly occur in the:
- Putamen
- Thalamus
- Subcortical white matter
- Pons
- and Cerebellum .
- They can also present as lobar hemorrhages.
Which common ICH is shown?
Pons
Typical Locations of Intracerebral hemorrhages
- Hypertensive ICH’s commonly occur in the:
- Putamen
- Thalamus
- Subcortical white matter
- Pons
- and Cerebellum .
- They can also present as lobar hemorrhages.
Which common ICH is shown?
Cerebellum
Typical Locations of Intracerebral hemorrhages
- Hypertensive ICH’s commonly occur in the:
- Putamen
- Thalamus
- Subcortical white matter
- Pons
- and Cerebellum .
- They can also present as lobar hemorrhages.
Which common ICH is shown?
lobar hemorrhage
Typical Locations of Intracerebral hemorrhages
- Hypertensive ICH’s commonly occur in the:
- Putamen
- Thalamus
- Subcortical white matter
- Pons
- and Cerebellum .
- They can also present as lobar hemorrhages.
- Which 2 locations often extend into ventricles?
- What are the 3 common causes of lobar hemorrhages?
Morbidity and Mortality of Intracerebral Hemorrhage
- What is the 2-day mortality rate?
- What is the 30-day mortality rate?
- How many patients live past 6 months?
Underlying Conditions for ICH
- HTN
- What does this do the walls of small/medium penetrating vessels?
- Where in the brain is this most likely to occur? (4)
Underlying Conditions for ICH
- Cerebral Amyloid Angiopathy
- What kind of hemorrhage is this the most common cause of?
- Does this affect deep or superficial brain tissues?
- What does the amyloid deposition do to the vessels? (5)
Underlying Conditions for ICH
- Other causes of NON-Traumatic ICH
- What are 3 causes of ICH, aside from HTN and Amyloid deposition? (3)
- (Not Risk Factors)
- What are 3 causes of ICH, aside from HTN and Amyloid deposition? (3)
Risk Factors for ICH
- What are 3 common risk factors for stroke, aside from HTN and amyloid deposition?
ICH Presentation
- What kind of activity do these occur with?
- What is notable about the onset and severity of signs/symptoms?
- Why do HA and vomiting occur? How common is this?
- What can blood leaking into the CSF lead to?
- What kind of hemorrhage is associated with vertigo and balance issues?
Pathophysiology of ICH
- What actually causes the direct mechanical injury to the brain parenchymal?
Underlying Conditions for ICH
- Hematoma
- What happens over the first 24 hours after this forms?
- What does perihematoma edema develop?
- When does this edema peak?
Diagnostic Workup for ICH
- What 2 types of CT’s should you run?
- What are you looking for aside from a hematoma?
- What kind of labs should you run? (3)
Tx of ICH
- What is the first thing you do in all emergency situations? (The AB of ABCDE)
Tx of ICH
- After the airway and breathing have been assessed, what do things need to be checked/treated? (Related to the C in ABCDE)
- Just state what needs to be done, do not explain how to do it yet
Circulation: Anti-Coagulation Tx and BP control
Tx of ICH: Reverse Coagulopathy
- What 4 drugs can be considered?
- What is idarucizumab?
- How do you treat thrombocytopenia
Tx of ICH: BP Control
- What do many PTs with ICH have?
- What do you want to get a patients systolic BP to?
- Does this change the neurologic outcome?
- What 3 drugs can be administered?
Tx of ICH: Seizures
- If an ICH has a seizure, what drug do you use to STOP the seizure and at what dosage?
- What drug follows this and what dose do you give?
- What must you be ready to do?
ICH: Mechanisms of Brain Injury
- What causes mechanical brain injury?
- What does increased brain edema lead to? (3)
ICH and Tx to minimize Secondary Brain Injury
- What are the goals of this treatment? (2)
- What is CPP?
Cerebellar Hemorrhages
- What symptoms do patients present with? (5)
- Do they have a negative or positive HINTS test?
- What is notable about the posterior fossa that causes an increased risk for rapid deterioration of a patients condition?
- When is surgery indicated?
Vertebral Artery Dissection
- What kind of stroke does this present as?
- How does this relate to age and activity during the stroke?
- Why do these occur?
What is this?
Subarachnoid Hemorrhage
Subarachnoid Hemorrhages
- What happens in about 1/3 of these cases?
- When does it occur?
- Where does blood go?
- How do patients present’?
Subarachnoid Hemorrhages
- Where do about 90% of saccular aneurysms occur?
- How do AVMs relate to this?
Subarachnoid Hemorrhages
- What is notable about the headache?
- What other symptoms can the patient present with?
- What disease is associated with this?
- How do genetics relate to this?
- How do unruptured expanding aneurysms present?
Subarachnoid Hemorrhages: Dx
- What is the initial test conducted?
- How sensitive is this?
- What does the sensitivity decrease?
Subarachnoid Hemorrhages: Dx
- How many samples do you collect, and at what volume?
- What do you do with these samples?
- What are the 2 things that will indicate a positive test?
Subarachnoid Hemorrhages: Dx
- Lumbar Puncture and Xanthochromia
- Where are these present in CSF?
- What does it breakdown?
- How do you inspect for this?
Subarachnoid Hemorrhages: Dx
- What kind of imaging is this?
- What is at the yellow arrow?
Subarachnoid Hemorrhage: Pathophysiology
- What is notable about the mortality rate for this?
- Complications
- What does ischemia cause?
- Why does vasospasm occur?
- What do you use to treat vasospasm?
- What other complications exist?
Surgical Tx for Aneurysms
- What 2 treatments are performed?
Traumatic Subarachnoid Hemorrhage
- What are these usually associated with?
- Why is there no vasospasm?
Subarachnoid Hemorrhage
- Pitfalls
- Why is there a high rate of misdiagnosis at the intial presentation? (2)
AVMs
- When do these form?
- What do these appear as?
- What are these best seen with?
- What do these present as with?
- What kind of hemorrhages are commonly associated with this?
What is shown here?
