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bm3052 > Haem. stroke & Aneurysms > Flashcards

Haem. stroke & Aneurysms Flashcards

1
Q

Causes of Aneurysms

A
  • weakness in BV present at birth
  • HP in weak BV
  • previous aneurysm
  • Race( African Americans are more likely to have a SA hemorrhage)
  • fatty plaques which cause BV weakness
  • inherited disease that weaken BV
  • gender( woman more likely to dev a brain aneurysm/suffer a SA hemorrhage)
  • trauma
  • STIS like syphilis
  • PCKD
  • infection
  • unknown
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2
Q

3 main locations of an aneurysm

A
  1. cerebral 2. thoracic aortic 2. abdominal aortic
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3
Q

symptoms of a ruptured vs unruptured cerebral anuerysm

A

unraptured tend to have no related symptoms but ruptured include severe headaches with rapid onset, neck pain and stiffness, increasing drowsiness, paralysis, impaired speech and visual problems

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4
Q

the symptoms of a cerebral ruptured aneurysm are associated with…

A

location of the bleed

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5
Q

most common type of anneurysm is

A

saccular and this accounts for 80-90% intracranial aneurysm

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6
Q

4 main types of cerebral aneurysm

A
  1. saccular 2.fusiform 3.giant 4.dissecting
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7
Q

Ruptured brain aneurysms are fatal in…. Of the people that do survive how many suffer permanent neuro deficit

A

40%, 66%

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8
Q

saccular aneurysms are the most common…

A

cerebral aneurysm(80-90%)

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9
Q

Fusiform aneurysms

A
  • less common type - an outpoching of an arterial wall on both sides and dont have neck or stem
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10
Q

Giant aneurysm size and risk

A

>2.5cm and have a high and can be diff to treat

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11
Q

percentage of saccular aneurysms that dont rupture

A

50-80%

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12
Q

define

size of most saccular aneurysms

A

0.5 to 2cm

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13
Q

saccular aneurysm size and lcoation

A

tend to be rounded lobulated focal outpoucgings which usually arise at the arterial bifurcation and may arise from the lateral wall

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14
Q

define

Dissecting aneurysm

A

creates a false lumen and tends to be the most damaging type of aneurysm as it thins the vessel wall and can usually end up being quite large

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15
Q

T/F

The prevalnce of AA increases with age

A

true

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16
Q

T/F

Rupture of aa is associated with 70% mortality

A

false, it is 80%

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17
Q

T/F

surgical repair of ruptured AA has a 50% mortality

A

true

18
Q

As a consequence of increased mortality associated with AA and ruptured aa…

A

screening men over 65 reduced aneurysm related mortality

19
Q

Patients diagnosed eith small AA should have…

A

ongoin surveillance with ultrasound and CV risk factor modif

20
Q

Things to consider when treating an unruptured Aneurysm

A
  • risk of hemorrhage/ rupture probabbility
  • size and location
  • age and health of patient family history
  • aneurysm ruptured? recurring storke?
  • surgical risks
21
Q
A
22
Q

Treatment for an unruptured aneurysm

A
  1. Surgical clipping
  2. Endovascular coiling
23
Q

Surgical Clipping

A

The neurosurgeon removes a section of skull to access the aneurysm and locate the BV that feeds it. They place a small clip on the neck of the aneurysm to stop BF

24
Q

Endovascular coiling

A

can reach via a stent to enter the vessel then the coil enters the space to increase the structural integrity of the vessel and prevent rupture

25
Q

2 types of Haemorhaggic stroke

A

Intracerebral and Subarachnoid

26
Q

Percentage breakdown of each type of stroke and frequency

A

embolic- 25%

thrombotic - 60%

subarachnoid- 5%

intracerebral-10%

27
Q

Pharmacological agents for HS

A

We can use osmotic agents to reduce edema and IC pressure following a HS. e.g mannitol infusion

28
Q

Mannitol infusion

A

used to raise serum osmolarity as it is a high sucrose solution thus pulling fluid from tissue to blood

29
Q

Adverse events of using mannitol for ruptured aneurysm

A
  • 10% of patients will develop edema because the BBB tends to become leaky post-stroke thus the gradient may not be ensured
  • can be very dangerous depending on site of the brain
30
Q

surgical treatment for HS or ruptured aneurysm

A
  • surgical clipping
    • depends on where and how bad the damage is
  • endovascular coiling
    • filling and natural clotting can still plug the ruptured aneurysm
  • surgical repair(aortic aneurysm)
    • 50% effective
31
Q

4 types of ischaemic stroke models

A
  1. middle cerebral artery occlusion
  2. photothrombotic stroke
  3. endothelin-1 stroke
  4. embolic stroke
32
Q

Haemorrhagic stroke model

A
  1. autologous blood injection
  2. t-PA induced stroke
  3. endovascular puncture
33
Q

Middle Cerebral Artery Occlusion advantages

A
  • mimics human stroke as most common human stroke is MCAO
  • reperfusion and duration is controlled
  • BF is measured
  • Most common model
34
Q

Cons of MCAO

A
  • Variable infarct damage
  • invasive surgery
    • animals cant be studied longterm
35
Q

Photothromotic Stroke Pros

A
  • induces a thrombus
  • minimal surgical intervention
    • popular with the animal ethics people
  • highly reproducible infarct damage
  • can control where to induce the stroke well
36
Q

Photothrombotic stroke Cons

A
  • little or no pneumbra
  • unable to measure BF
37
Q

Endothelin Model Pros

A
  • Conscious model of stroke
  • repro infarct damage
  • low mortality
38
Q

Endothelin Model Cons

A
  • induces astrocytosis and facilitates axonal sprouting
  • unable to measure BF
  • lacks a BBB breakdown
39
Q

Endovasc model Pros

A
  • closely mimics SAH in clinic
  • BF can be measured with laser dopler
40
Q

Autologous blood injection model Pros

A
  • Blood is injected into the striatum to establish a hematoma
  • widely used model for HS as it has good repro and is relevant to ICH patients
41
Q

Autologous blood injection model Cons

A
  • Does not simulate BV rupture as there is no constant Blood supply
42
Q

Endovasc puncture model cons

A

invasive surgery

bm3052 (25 decks)

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