CVA Hemorrhagic

Question 1

What are the primary Hemorrhagic strokes?

Answer 1

Intracranial and subarachnoid bleeds

Question 2

Which type of stroke usually has more severe deficits: ischemic or hemorrhagic?

Answer 2

Hemorrhagic

Question 3

What area of the brain has a bleed if there is subarachnoid bleeding?

Answer 3

the back of the head

Question 4

What are 80% of hemorrhagic strokes related to: big vessels or small?

Answer 4

Most are from spontaneous rupture of small vessels that can turn into big bleeds

Question 5

What is the chief cause of hemorrhagic stroke?

Answer 5

Hypertension - a lot of patients don’t know or they are not compliant with care.

second is brittle vessels

Question 6

How can you tell someone is hypertensive?

Answer 6

Bright red face with popping vessels
Fatigued
Overweight

Question 7

What is a major cause for subarachnoid bleeds specifically?

Answer 7

Aneurysm due to the bulging breaking in 50% of subarachnoid cases

Question 8

Why are diabetics at high risk for hemorrhagic stroke?

Answer 8

Their vessels are brittle

Question 9

What causes symptoms to show for a hemorrhagic stroke?

Answer 9

Pressure on the cranial nerves due to the bleeding, the feeling of the aneurysm, or AVM

Question 10

What happens to ICP during hemorrhage?

What does this cause?

Answer 10

Exposure of blood causes an increase in ICP - which in turn causes ischemia from the pressure and vasospasms.

Question 11

What BP do we want for someone with a hemorrhagic stroke?

Answer 11

High. 160-180

Question 12

Why do we want to maintain a high BP of someone with a hemorrhagic stroke?

Answer 12

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.

Question 13

What are the most common locations for bleeding with a hemorrhage?

Answer 13

Cerebral lobes
Basal ganglia
Thalamus
Brain stem (mostly pons)
Cerebellum

Question 14

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?

Answer 14

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.

Question 15

How long does it take for an aneurysm vessel to dilate?

Answer 15

Can go on for a while. Maybe even a week to months. And you can have multiple ones growing at a time.

Question 16

Bifurcation of large arteries in the circle of willis is the most common location for _____.

Answer 16

Aneurysms.

Question 17

How do doctors prevent someone with an aneurysm from stroking out?

Answer 17

Clipping the aneurysm

Question 18

Patient is having major vision changes and complaints of a lace curtain. What is a likely cause?

Answer 18

Aneurysm of the eye

Question 19

What 3 things can cause the subarachnoid hemorrhage?

Answer 19

Aneurysm (probably from circle of willis)
Trauma
Hypertension

Question 20

What are headaches like for a patient who is expereincing a hemorrhagic stroke?

Answer 20

Frequent severe headache that has an acute onset

Question 21

What neuro deficits will we see with hemorragic stroke?

Answer 21

Same as ischemic for the most part

Question 22

How can we tell between the ischemic or hemorrhagic stroke?

Answer 22

Diagnostic testing CT & MRI

Question 23

What type of seizures will hemorrhagic stroke patients have?

Answer 23

Focal seizures due to brain stem involvment

Question 24

What are strokes mistaken for?

Answer 24

Migraines a lot

Question 25

What causes the pain, rigidity in the neck and spine?

Answer 25

Meningeal irritation and vasospasm to compensate for collateral

Question 26

When do stroke patients have visual disturbances?

Answer 26

If adjacent to oculomotor nerve

Question 27

What can a severe brain bleed lead to?

Answer 27

Coma and death

Question 28

Common symptoms of hemorrhaic stroke specifically

Answer 28

Tinnitus, dizziness, hemiparesis

Question 29

How do older patients do with hemorrhagic stroke

Answer 29

Not as well

Question 30

What methods can prevent the hemorrhage stroke

Answer 30

Screen for high risk individuals and educate them Manage hypertension
Avoid excessive alcohol intake bc it thins out the blood

Question 31

Why do we have to be careful when giving hypertension meds to stroke patients?

Answer 31

Labetolol
Nicardipine
Nitroprusside
Hydrazaline 
- we don't want to drop the BP below 160-180.

Question 32

What are the complications of managing stroke slide 1?

Answer 32

1. Cerebral hypoxia and decreased blood flow
   - due to the loss of blood and then building of………. 2. ICP
2. Hypertension control can be hard (since we want them in that 160-180 systolic)

Question 33

What are complications of managing stroke slide 2?

Answer 33

1. Vasospasms can occur 3-14 days after
   - bc the brain is able to perfuse now
2. Worsening headahce, change in LOC, and new focal neuro deficit can show up

Question 34

Other tx for stroke?

Answer 34

Fluid volume expanders
Induced arterial hypertension
Hemodilution

Question 35

Main medical goal

Answer 35

Allow brain to recover from initial insult and protect from any re-bleeding or complications