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Neurology > Brain Bleeds > Flashcards

Brain Bleeds Flashcards

1
Q

Define stroke and TIA.

A

Stroke: Acute focal/global loss of brain function of vascular origin lasting >24h

TIA: Stroke with symptoms lasting <24 hours

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2
Q

Why are TIAs important to recognise?

A

Major risk factor for stroke

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3
Q

What are the two broad classes of stroke and what causes the symptoms?

Which is the commonest?

A

Ischaemic (stroke caused by occlusion/stenosis of cerebral artery)

Haemorrhagic (stroke caused by vascular rupture and bleeding intro brain parenchyma)

Ischaemic strokes 90% of strokes

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4
Q

Stroke causing paralysis of one body side, homoymous hemianopia and cortical dysfunction.

What kind of stroke is it?

What arteries may be affected?

A

Total anterior circulation stroke (TACS)

Middle/anterior cerebral arteries.

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5
Q

What are the diagnostic criteria for total anterior circulation stroke (TACS)?

A 
Hemiplegia
and
Homonymous hemianppia
and
Cortical dysfunction
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6
Q

What are the diagnostic criteria for partial anterior circulation stroke (PACS)?

A

2/3 of

Hemiplegia
Homonymous hemianopia
Cortical dysfunction

(2/3 of TACS criteria)

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7
Q

What are the diagnostic criteria for lacunar syndrome (LACS)?

A 
Pure sensory/motor stroke
or
Ataxic hemiparesis
without
Cortical dysfunction

(can also get mixed sensorimotor stroke but less common)

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8
Q

What causes lacunar syndrome (LACS)?

A

Small infarcts in deep brain (e.g basal ganglia)

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9
Q

Stroke without cortical dysfunction.

Which type of stroke does this suggest?

A

Lacunar syndrome (LACS)

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10
Q

How might a posterior circulation syndrome (POCS) stroke present?

A

Cerebellar dysfunction

Cranial nerve palsy

Bilateral deficit

Eye movement disorder/homonymous hemianopia

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11
Q

What arteries are disrupted in posterior circulation stroke (POCS)?

A

Cerebellar/brainstem arteries

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12
Q

Risk factors for stroke.

A 
Old age
Hypertension
Cardiovascualr disease
AF
Coagulopathy
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13
Q

Why is laterality of stroke important to assess?

A

Implications for rehabilitation

Dominant hemisphere strokes can affect language

Non-dominant hemisphere strokes can affect spatial awareness and cause neglect

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14
Q

What is the commonest cause of stroke?

A

Ischaemic atheroembolic stroke

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15
Q

Name 3 causes of ischaemic stroke.

A

Atheroembolus
Cardioembolus
Small vessel disease (e.g. amyloid angiopathy)

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16
Q

What increases risk of cardioembolic stroke?

A

AF (or any other cardiac abnormality)

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17
Q

What is the commonest cause of haemorrhagic stroke?

A

Hypertension

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18
Q

What can cause haemorrhagic stroke?

A

Hypertension

Arteriovenous malformations

Amyloid angiopathy

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19
Q

What is the most important initial investigation in stroke and why?

A

CT scan

Determines if ischaemic or haemorrhagic

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20
Q

What type of stroke are CT scans better at picking up and why?

A

Haemorhgaic

Fresh blood shows up as clear white areas. Ishcaemic causes inflammation and oedema and the water content shows more subtle dark changes

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21
Q

In what scenario is an MRI scan better than a CT scan at picking up strokes?

A

Late presentation

CTs don’t show blood after about a week

22
Q

What would a CT scan show in

  1. very early presentation
  2. haemorrhagic stroke
  3. ischaemic stroke
  4. late presentation
A
  1. nothing (good predictor)
  2. white areas
  3. darker changes
  4. nothing (MRI better)
23
Q

What investigations should you perform in suspected stroke?

A

CT/MRI
Bloods
ECG

24
Q

How do you treat ischaemic stroke?

A

Alteplase (if within 4.5 hours and no thrombolysis contraindications)
and
Aspirin

25
Q

How do you treat haemorrhagic stroke?

A

Conservative (if not deteriorating)
Blood pressure control 140-180 systolic with labetalol

If deterioration (suggests haematoma), surgery

26
Q

What assessment must you perform in stroke patients?

A

Swallow assessment

27
Q

Where should stroke patients be treated and why?

A

Stroke unit

Associated with best outcomes

28
Q

What should be used to prevent DVT in stroke patients

A

Pneumatic compression device

29
Q

What surgical procedure can be done to reduce stoke risk in some patients?

How would you identify if this is needed?

A

Carotid endarterectomy

USS shows carotid stenosis

30
Q

Do statins lower stroke risk?

Does lowering cholesterol reduce stroke risk?

A

Yes

No (statins protective effect due to another mechanism)

31
Q

Secondary prevention of stroke.

A

Antithrombotic therapy

Blood pressure control (perindopril)

Statin

Diabetic control

Smoking cessation

Carotid endarterectomy

32
Q

List layers encountered from skin-brain.

A 
Skin
Skull
Dura mater
Arachnoid mater
Subarachnoid space
Pia mater
Brain
33
Q

Young patient hits head. If okay for a few hours before deteriorating and losing consciousness.

Diagnosis?

A

Extradural/epidural haematoma

34
Q

What is an extradural haematoma?

A

Collection of blood between skull and dura mater.

35
Q

What vasculature is implicated in extradural haematoma and why?

A

Middle meningeal artery

Lies underneath weak pterion

36
Q

What would be seen on CT in extradural haematoma?

A

Bleed (white area)

In circular shape (orange shaped)

37
Q

How do you treat extradural haematomas?

A

Surgical drainage

38
Q

What serious complication can occur in extradural haematomas?

A

Tonsillar herniation/coning (cerebral tonsils move into foramen magnum from raised ICP from blood)

39
Q

How does tonsillar herniation present?

A

Respiratory arrest

Cushing’s triad: hypertension, bradycardia, irregular breathing

40
Q

Old person hits head and develop worsening N+V, headache and have a reduced mental state.

Diagnosis?

A

Subdural haematoma

41
Q

What is a subdural haematoma?

A

Collection of blood between dura mater and arachnoid mater.

42
Q

What would be seen on CT in subdural haematoma?

A

Blood (white areas)

In banana shape

43
Q

What vasculature is implicated in subdural haematomas and why?

A

Bridging veins

Bridging veins cross subdural space and with head injury, can tear.

44
Q

How do you treat subdural haematomas?

A

Surgery to fix the veins

45
Q

How do you distinguish between extradural and subdural harmatomas clinically?

A

Age
Young patients get extradural haematomas as the dura sticks the the skull more as you age. Old people get subdural haematomas as the brain shrinks as you age, increasing the subdural space and streching the bridging veins, making them susceptible to rupture.

Symptoms post trauma
Extradural haematomas often have lucid period initially before deteriration. Subdural haematomas don’t have this.

46
Q

Neck stiffness, photophobia, headache, sudden onset severe headache and focal neurological deficit.

Diagnosis?

A

Subarachnoid haemorrhage

47
Q

What is subarachnoid haemorrhage?

A

Bleeding into subarachnoid space commonly caused by rupture of a berry aneurysm

48
Q

What genetic condition is associated with subarachnois haemoarrhage?

49
Q

Why do patients get meningism in subarachnoid haemorhage?

A

Blood causes inflammation of meninges

50
Q

How do you manage subarachnoid haemorrhage?

A

CT
- Shows white areas (blood)

LP (if CT negative)

  • Red (blood)
  • Xathochromic/yellow (blood breakdown products)

GD coils (first line) or surgical clipping (second line) to prevent rebleeding

51
Q

Worsening headache and fluctuating neurological deficit after subarachnoid haemorrhage.

  1. Differential?
  2. Diagnosis?
  3. Management?
A
  1. Delayed ischaemic neurolgical deficit (DIND) - cerebral ischaemia from delayed vasoplasm

Hydocephalus

  1. CT
  2. DIND - Hydration and nimodipine
    Hydocephalus - external ventricular drain
52
Q

How do you treat hyponatreamia caused by subarachnoid haemorrhage?

A

Fludrocortisone/Na supplements

DO NOT TREAT WITH FLUOD RESTRICTION AS CAUSES DIND

Neurology (11 decks)

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