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SSP > Chapter 6. Guidelines of the Management of Hemorrhagic Stroke > Flashcards

Chapter 6. Guidelines of the Management of Hemorrhagic Stroke Flashcards

1
Q

Incidence of ICH

A

24.6/100,000

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2
Q

This is the classification of ICH based on Etiology

A 
SMASH-U
Structural lesion
Medication
Amyloid
Systemic Disease
Hypertension
Undetermined cause
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3
Q

This is secondary to weakened arteriolar walls and formation of microaneurysm

A

Charcot Bouchard Aneurysm

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4
Q

This is the most important cause of ICH in elderly and non-hypertensive

A

Cerebral amyloid angiopathy (CAA)

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5
Q

What are clues for CAA

A

lobar hemorrhage
Multiple
non-hypertensive

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6
Q

Sites of predilection of ICH

A 
Basal ganglia 40-50%
Lobar - 20-50%
Thalamus - 10-15%
Pons 5-15%
Cerebellar 5-10%
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7
Q

What blood vessel rupture in putaminal hemorrhage

A

Ascending lenticulostriate

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8
Q

What blood vessel rupture in thalamic hemorrhage

A

Thalamogeniculate of PCA

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9
Q

What blood vessel rupture in pontine hemorrhage

A

paramedian branch of basilar artery

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10
Q

What blood vessel rupture in Cerebellar hemorrhage

A

penetrating branch of PICA, AICA and SCA

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11
Q

This area when ruptures is considered as neurological emergency

A

inferior cerebellar hemorrhage

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12
Q

This scoring predict patient with ICH to attain independence at 90 days

A

FUNC score

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13
Q

When to treat BP of patient with ICH

A

SBP > 180

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14
Q

What are the treatment for bleeding abnormality secondary to elevated INR to VKA

A
  1. Vit K with FFP

2. Prothrombin complex conc alternative to FFP

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15
Q

What are the treatment for bleeding abnormality secondary to NOACs

A
  1. Activated cvharcoal
  2. INR reversal by Platelet concentrate and recombinant FVIIa
  3. Vit K
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16
Q

The only approved AED prophylactic use

A

Giant Aneurysm

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17
Q

What is the agent used to reduce cerebral vasospasm

A

MgSO4

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18
Q

Classification of timing of surgery in SAH

A

Early: within 72 hours
Late: beyond 3 days

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19
Q

Who are the candidates for early surgery in SAH

A
  1. good to moderate grade anuerysm

2. Poor grade aneurysm with hydrocephalus and hematoma

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20
Q

Surgery can be delayed in SAH in the presence of

A
  1. ischemia

2. Severe angiographic vasospasm

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21
Q

This is a high flow high pressure vascular lesion that shunts arterial blood to venous system via nidus

A

Cerebral AVM

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22
Q

Bleeding risk of Cerebral AVM

A

2-4% per year

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23
Q

Mortality rate of AVM

A

10%

24
Q

Presentation of AVM

A

Hemorrhage 50%

Seizure 25%

25
Q

This occur due to siphoning of blood flow away from the adjacent brain tissue

A

Vascular steal syndrome

26
Q

Candidate for Immediate Surgery in ICH

A
  1. Cerebellar hemorrhage > 3 cm who are deteriorating
  2. ICH secondary to structural lesion (AVM etc)
  3. Clinically deteriorating patient esp young with moderate to severe lobar hemorrhage
  4. Ventricular draining for patient with IVH and hydrocephalus
27
Q

Non-candidate for surgery

A
  1. Small hemorrhage
  2. GCS < 5
  3. Pontine and midbrain hemorrhage
28
Q

Sensitivity of SAH based on ictus

A

12 hours - 98-100%
24 hours - 93%
6 day - 57 - 85%

29
Q

What is the gold standard diagnostic tool for SAH

A

DSA

30
Q

When is the ideal time to repeat a negative DSA result in SAH

A

7-14 days

31
Q

What is the equation of ICH lifetime risk in patient with AVM

A

= 105 - patient age in years

32
Q

What is the consistent risk factors that may predispose to bleeding in AVM

A

Deep venous drainage
Single draining vein
Venous stenosis
Elevated MAP in feeding artery

33
Q

What are the phases of DSA vascular structures

A 
Early arterial (1-2secs)
Late arterial (2-3secs)
Capillary (3-4secs)
Early venous (5-6secs)
Late venous (6-7secs)
34
Q

Abnormalities in Early arterial

A

AVF - feeding arteries

AVM - feeding arteries

35
Q

Abnormalities in late arterial

A

AVF - draining veins and sinuses

AVM - nidus

36
Q

Abnormalities in capillaries

A

AVM - Draining vessels and veins

37
Q

Eloquent areas

A 
Dominant hemisphere
Hypothalamus
Thalamus
Brainstem
Cerebral peduncle
38
Q

This scoring can predict the surgical risk of patient with AVM

A

Martin Speltzer

39
Q

AVM score for radiosurgery

A

(0.1) (volume) + 0.02 (age) + (0.5) (location)

40
Q

Interpretation of AVM score

A

<1 - 89%
1.01-1.5 - 70%
1.51 - 2.00 - 64%
> 2.00 - 46%

41
Q

What is the obliteration rate of SRS in AVM

A

60-90%

42
Q

What is the perioperative complication of SRS

A

28%

43
Q

What is the reduction rate of gamma knife after 2 years

A

91%

44
Q

What is the management of SM I & II

A

Surgical excision

45
Q

What is the management for SM IIIa

A

Microsurgery and embolization

46
Q

What is the management for SM IIIb

A

SRS with or without embloization

47
Q

What is the management for SM IV and V

A

conservative and palliative

48
Q

Rate of hemorrhage without bleeding in AVM

A

1.4%

49
Q

What is the trial that compared the outcome of medical vs surgical management of AVM

A

ARUBA tria;

50
Q

What is the outcome of SM I and II

A

SM I - 92-100%

SM II - 94-95%

51
Q

What is the outcome of SM IV and V

A

SM IV - 71-75

SM V - 50-70%

52
Q

The success rate of SRS in 2-3 years

A

60-90%

53
Q

Hemorrhage rate of SRS

A

4.8% first 2 years

5% 3-5th year

54
Q

3 Goals of SRS

A
  1. Decrease target size to < 3 cm
  2. Eradicate angiographic predictor of hemorrhage
  3. Decrease symptoms related to venous hypertension
55
Q

What is the recanalization rate of SRS

A

14-16%

SSP (7 decks)

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