CVA Hemorrhagic Flashcards
What are the primary Hemorrhagic strokes?
Intracranial and subarachnoid bleeds
Which type of stroke usually has more severe deficits: ischemic or hemorrhagic?
Hemorrhagic
What area of the brain has a bleed if there is subarachnoid bleeding?
the back of the head
What are 80% of hemorrhagic strokes related to: big vessels or small?
Most are from spontaneous rupture of small vessels that can turn into big bleeds
What is the chief cause of hemorrhagic stroke?
Hypertension - a lot of patients don’t know or they are not compliant with care.
second is brittle vessels
How can you tell someone is hypertensive?
Bright red face with popping vessels
Fatigued
Overweight
What is a major cause for subarachnoid bleeds specifically?
Aneurysm due to the bulging breaking in 50% of subarachnoid cases
Why are diabetics at high risk for hemorrhagic stroke?
Their vessels are brittle
What causes symptoms to show for a hemorrhagic stroke?
Pressure on the cranial nerves due to the bleeding, the feeling of the aneurysm, or AVM
What happens to ICP during hemorrhage?
What does this cause?
Exposure of blood causes an increase in ICP - which in turn causes ischemia from the pressure and vasospasms.
What BP do we want for someone with a hemorrhagic stroke?
High. 160-180
Why do we want to maintain a high BP of someone with a hemorrhagic stroke?
Their body is used to that high pressure. And if we were to drop it too low, we would cause vasospam tightening that makes it worse.
What are the most common locations for bleeding with a hemorrhage?
Cerebral lobes Basal ganglia Thalamus Brain stem (mostly pons) Cerebellum
Why is it that a hemorrhage patient could end up with the intra-ventricular hemorrhage on top of their already existing hemorrhage (in the ventricles)?
Why is this important to avoid?
Rupture of the lateral ventricle can occur and cause more pressure on the ventricles and then the bleed is even bigger.
If it gets to this point, they will be losing a lot of blood and its very fatal.
How long does it take for an aneurysm vessel to dilate?
Can go on for a while. Maybe even a week to months. And you can have multiple ones growing at a time.
Bifurcation of large arteries in the circle of willis is the most common location for _____.
Aneurysms.
How do doctors prevent someone with an aneurysm from stroking out?
Clipping the aneurysm
Patient is having major vision changes and complaints of a lace curtain. What is a likely cause?
Aneurysm of the eye
What 3 things can cause the subarachnoid hemorrhage?
Aneurysm (probably from circle of willis)
Trauma
Hypertension
What are headaches like for a patient who is expereincing a hemorrhagic stroke?
Frequent severe headache that has an acute onset
What neuro deficits will we see with hemorragic stroke?
Same as ischemic for the most part
How can we tell between the ischemic or hemorrhagic stroke?
Diagnostic testing CT & MRI
What type of seizures will hemorrhagic stroke patients have?
Focal seizures due to brain stem involvment
What are strokes mistaken for?
Migraines a lot
What causes the pain, rigidity in the neck and spine?
Meningeal irritation and vasospasm to compensate for collateral
When do stroke patients have visual disturbances?
If adjacent to oculomotor nerve
What can a severe brain bleed lead to?
Coma and death
Common symptoms of hemorrhaic stroke specifically
Tinnitus, dizziness, hemiparesis
How do older patients do with hemorrhagic stroke
Not as well
What methods can prevent the hemorrhage stroke
Screen for high risk individuals and educate them Manage hypertension
Avoid excessive alcohol intake bc it thins out the blood
Why do we have to be careful when giving hypertension meds to stroke patients?
Labetolol Nicardipine Nitroprusside Hydrazaline - we don't want to drop the BP below 160-180.
What are the complications of managing stroke slide 1?
- Cerebral hypoxia and decreased blood flow
- due to the loss of blood and then building of………. 2. ICP - Hypertension control can be hard (since we want them in that 160-180 systolic)
What are complications of managing stroke slide 2?
- Vasospasms can occur 3-14 days after
- bc the brain is able to perfuse now - Worsening headahce, change in LOC, and new focal neuro deficit can show up
Other tx for stroke?
Fluid volume expanders
Induced arterial hypertension
Hemodilution
Main medical goal
Allow brain to recover from initial insult and protect from any re-bleeding or complications
