CNS HEMORRHAGE

Question 1

most common type of cns hmg

Answer 1

intracranial

Question 2

most common reason of ich

Answer 2

hypertension

Question 3

other etiologies

Answer 3

arteriovenous malformations (AVMs) and cocaine use in younger patients and amyloid angiopathy in the elderly, are often responsible.

Question 4

best outcome predictor

Answer 4

size of the haematoma and size greater than 60 cc has a 30 day mortality of over 30 %

Question 5

pathogenesis of neurological damage

Answer 5

haematoma expansion inthe first 24 hours followed by edems on 3-7 days

Question 6

most common sites of ich

Answer 6

Most common sites of hypertensive ICH are the basal ganglia, deep cerebellum, and pons.

Question 7

blood pressure management in ich

Answer 7

The mean arterial pressure (MAP) should be kept between 100 and 120 mmHg, to maintain brain perfusion without increasing the edema surrounding the hematoma. Agents such as beta-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors are generally considered safe, since they do not increase ICP, while nitrates and sodium nitroprusside are generally avoided since they can suddenly increase ICP.

Question 8

role of neurosurgical intervention

Answer 8

surgery is likely to be of minimal benefit as shown inthe recent STITCH trial.
the indicators of surgery are
1.infratentorial i.e posterior fossa or temporal lobe hmg greater than 3 cm
2. ich causing hydrocephalus or brainstem compression

the role of early surgery in casr of a superficial supratentorial hmg is controversial

Question 9

post ich anticoagulation management

Answer 9

In the presence of a clear indication for anticoagulation (e.g., mechanical
heart valve) or antiplatelet therapy (e.g., coronary artery stents), it is reasonable to
restart anticoagulation in nonlobar ICH in 2 to 4 weeks and antiplatelet therapy in all
ICH 1 to 2 weeks after documentation of cessation of bleeding.

Question 10

most common site 0of intra cranial aneurysm

Answer 10

at the bifurcation of arteries of circle of willis mostly in the anterior circulation
the anterior cerebral artery
internal carotid artery

Question 11

which part of the aneurysm sac is prone to rupture

Answer 11

the dome

Question 12

in which of the following focal neurological signs are more common SAH or ICH

Answer 12

ICH

Question 13

incidence and mortality of rebleed

Answer 13

The incidence of rerupture of an untreated aneurysm is about 30%, mostly occurring in the first 48 hours after the initial event and having a 60% mortalitity

Question 14

target map for sah

Answer 14

100 to 120