Consolidation slides Flashcards
Types of Intracranial Haemorrhage
1) Epidural haemorrhage
2) Subdural haemorrhage
3) Subarachnoid haemorrhage
4) Intraparenchymal haemorrhage
The cause of Epidural haemorrhage
Head trauma -> skull fracture from blunt trauma-> laceration of arterial vessels (most commonly meningeal artery)
more tremendous force is required than subdural haemorrhage
The cause of subdural haemorrhage
Head trauma -> rupture of bridging veins
Elderly/ alcoholics are more susceptible, can occur with minor head trauma
Anticoagulation meds
The cause of subarachnoid haemorrhage
Rupture of saccular, or berry, aneurysum (80%); and rupture of arteriovenous malformation (AVM) (10%)
Known risk factor of aneurysm rupture (4)
- Tobacco use
- Alcohol abuse
- Hypertension caused by cocaine and other stimulants
- Large aneurysm size
The cause of Intraparenchymal haemorrhage
Damaged blood vessels due to:
- HTN
- Cerebral amyloid angiopathy
- Head trauma
- Ruptured aneurysm
- Blocked vessels
Presentation of EDH
Triphasic Presentation
S&S of EDH
Brief LOC -> Lucid interval -> headache, progressive obtundation (altered level of consciousness), hemiparesis (contralateral) -> “ blown pupil” (ipisilateral) secondary to uncal herniation
Presentation/ signs and symptoms of SDH
Non-specific clinical signs including
Headache, altered mental status, hemiparesis
Non-convulsive seizure may occyr in 20% of patients with acute SDH
Can be subacute or chronic
Gradual change in mental status may present as delirium or dementia in elderly, careful history will reveal remote fall
Presentation of SAH
Aneurysmal SAH is typically characterised by explosive or “thunderclap headache” instantaneously maximal at onset, “worst”
Normally associated with activities
Presentation of ICH
FAST + headache
occur without warning
s&s depend on location affected
Weakness of the left arm, leg and face (damage to?)
Damage to the motor area of the right cerebral hemisphere
Speech problem damage to the ?
Broca’s area
Small stroke in the ________ can cause severe problems as many __________ pass through here from the brain to the spinal cord
brain stem, nerves
loss of co-ordination in the right arm and leg is caused by the damaged to
left parietal lobe
difficulty in understanding speech, reading, naming object is caused by the damage to the
wernicke’s area
Unsteadiness and poor co-ordination is the damage to the
cerebellum
TIA vs Established stroke
TIA pathogensiesis vs Established stroke
Transient Ischemic Attacks
(TIA)
- Any neurological dysfunction that lasts for a few seconds to a few minutes
- Should recover within 24
hours - Pathogenesis of TIA
- Low-flow states in vascular
obstruction - Small emboli which get
dissolved later - Recognition of TIA helps in
prevention of major stroke
Established stroke
- Infarction of brain tissue occurs due lack of blood. Deficit is permanent
- Increasing obstruction may
involve a proximal branch of the artery and increase the deficit: stroke-in-evolution - Edema occurs in surrounding tissue
- Resolution of edema after the acute stage may restore some function
Non modifiable risk factor of ischemic stroke (8)
- Age
- Race
- Sex
- Ethnicity
- History of migraine headaches
- Sickle cell disease
- Fibromuscular dysplasia
- Heredity
Modifiable risk factor of ischemic stroke
- HTN
- DM
- Hypercholesterolemia
- TIA
- Carotid stenosis
- Oral contraceptive use
- Cardiac disease
1) AF
2) Valvular disease
3) Prosthetic valve
4) Mitral stenosis
-Lifestyle issues:
1) Excessive alcohol intake
2) Tobacco and illicit drug use
3) Obesity and physical inactivity
Lumbar puncture indication
CNS infection – meningitis
Thunderclap headache to rule out SAH when CT/MRI is normal or beyond 3
days
Lumbar puncture is to evaluate _____________________.
To evaluate for normal pressure hydrocephalus
Contra-indication of Lumbar puncture
Presence of infection in the tissues near the puncture site
- Presence of SOL (space occupying lesion)
- Bleeding tendencies (plt < 80 or INR > 1.4)
Types of epileptic seizures (6) Generalised seizures
Generalized tonic-clonic
Absence
Myoclonic
Clonic
Tonic
Atonic