Chapter 57B. Intracerebral Hemorrhage

Question 1

Question 57B-1: 
Which  is  the greatest risk factor for intracerebral hemorrhage? 
A.  Aneurysm 
B.  Anticoagulation 
C.  Atherosclerotic disease 
D.  Hypertension

Answer 1

Answer 57B-1: D.
Hypertension is, by far, the greatest risk factor
for ICH, although all of the other listed
entities are risk factors as well. (P 1251)

Question 2

Question 57B-2:
what is the implication of ICH as a complication of intra-arterial thrombolytic therapy?
A. A rare complication with a good prognosis
B. A rare complication with a poor prognosis
C. A common complication with a good prognosis
D. A common complication with a poor

Answer 2

Answer 57B-2: D.
ICH occurs in more than 10% of patients with
intra-arterial thrombolysis of the MCA, in one
study. In general, the hemorrhages are large
and carry a poor prognosis. (p1255)

Question 3

Question 57B-3: 
A 25-year-old man is brought to the ED 
Having collapsed  at home. He has a right hemiparesis  with marked  encephalopathy. Hisis known to use cocaibe reguraly and drug screen is positive. Which is the diagnosis? 
A.  IntraparenchymaI hemorrhage 
B.  Subarachnoid hemorrhage 
C.  Cerebral infarction 
D.  Any of  these

Answer 3

Answer 57B-3: D.
Cocaine use is associated with infarction or
hemorrhage due to marked elevation of blood
pressure. Hemorrhagic transformation of infarction is also possible, and intraparenchymal and subarachnoid hemorrhage may coexist in the same patient.
(p1257)

Question 4

Question 57B-4 
A man is admitted because of  left hemiparesis and is found to have a right intraparenchymal hemorrhage on CT.  The blood is mottled with minimal mass effect There is no extension of the blood into the ventricular or subarachnoid space. What is the most likely cause of  the hemorrhage? 
A.  Aneurysmal hemorrhage 
B.  Hypertensive hemorrhage 
C.  Hemorrhagic infarction 
D.  Venous infarction with hemorrhage

Answer 4

Answer 578-4: C.
The description of the hemorrhage is typical
of hemorrhagic infarction. Primary intracerebral hemorrhage would be associated
with more mass effect with a dense,
homogenous hematoma. (p1258)

Question 5

Question 57B-5:
The image shows CT of a young man with stroke following cocaine use.

Which would be appropriate therapy for this patient?
A. Medical management
B. Open surgical drainage
C. Opening of the skull to allow for increased ICP
D. Ventricular drainage

Answer 5

Answer 578-5: A.
Medical management is indicated for most
patients with deep hypertensive hemorrhages,
especially when there is minimal mass effect
or intraventricular extension. (p1266)