haemorrhagic stroke

Question 1

describe the falx cerebri

Answer 1

major dura fold
dura mater between longitudinal fissuer
divides left + right hemisphers

Question 2

describe tentoruim cerebelli

Answer 2

forms tent partition between cerebrum + cerebellum

above tentorium space, below infratentorial space

Question 3

describe the dura mater

Answer 3

periosteal layer adheres to skull
meningeal layer adheres to aracnoid mater
loosely covers brain
subdural space

Question 4

describe arachnoid mater

Answer 4

csf reabsoprtion
finger projections penetrate meningeal layer of dura
subarachnoid space = contains CSF

Question 5

describe pia mater

Answer 5

closely adheres to surface of brain

Question 6

name the common and non-spontaneous causes of intracerebral haemorrhage

Answer 6

common = long-standing hypetension
non-spontaneous = TBI

Question 7

describe the role of cerebral amyloid angiopathy in ICH

Answer 7

amyloid deposition on wallsof cerebral arteries

weakens wealls = haemorrhage

Question 8

what type od rupture in iCH and where does bleed

Answer 8

arterioles
deep, non-corticol structures
bleed in periphery of cerebral hemi = better outcome

Question 9

how do charcot-bouchard aneurysms occur and where

Answer 9

chronic hypertension => deposition lipid-hyaline substances in arteriole wall => weaken
minute aneurysms
deep brain where vessel diameter <300nm

Question 10

what are the clinical features of ICH

Answer 10

normal stroke symptoms +
severe headache 
vomiting 
rapid loss consciousness 
seizures

Question 11

outcomes of ICH

Answer 11

death 24-48 = common
survivors = motor cognitive deficits
management BP -> effect on cerebral ischaemia

Question 12

What is subarachnoic haemarrohage and why does it occur

Answer 12

blood in subarachnoid space => bloody CSF

commonly occur from berry aneurysms

Question 13

what are the biggest risk factors for SAH and what can is result from

Answer 13

• smoking hypertension, alcohol, genetics
• from vascular malformations, trauma, rupture of ICH into ventricular system, malignant hypetension,
  acute = shitting, orgasm

Question 14

what are berry aneurysms, where do they occur and what are their cause

Answer 14

small
branch at circle of willis
developmental defects in elastic lamina/acquired defects in artery
cause = infection, immunolgical, inflam, atherosclerotic, vascular
hypertension exacerbates defecit
rupture => SAH, or ICH

Question 15

what are the clinical features and outcomes of SAH

Answer 15

severe, sudden headache
nausea, vomitingstiff neck (meningeal irritation)
photophobia
blurred/double vision 
loss consciousness/seizures

oucomess = 30-50% mortality
imapcted by haemorrhage severirt, sex, age, treatment, comorbidities

Question 16

3 treatments for berry aneurysms

Answer 16

clip = blood cant pass through aneurysm
endovascular coiling = packed platinum coils via catheter = prevents passage blood => aneurysm
artery bypass = aneurysm blocked = blood diverted to new artery

Question 17

what are the complications of ICH or SAH

Answer 17

acute/chronic hydrocephalus
cerebral oedema
blood pool effects = iscaemia + infarction of adjacent structures, increased ICP, dec CPP, herniation syndromes, compression resp centres of brain stem

Question 18

what is a peri-haematomal oedema

Answer 18

complication of ICH
swelling around haematoma (clot)
worsens neuro outcomes 
expands quick 
treated by reduce cerebral oedema

Question 19

describe hydrocephalus

Answer 19

complication stroke
abnormal inc in V of CSF in skill
30% SAH
treatment = extraventricular drain

Question 20

describe vasospasm as a complication

its effects and treatments

Answer 20

decrease calibre of cerebral artery
effect of clotted blood and breakdown within brain
vasospasm => prog cerebral iscahemia/stroke -> cerebral oedema -> death
treatment = ca2+ blocker => prevent ichaemic injury, cause hypotension (need manage), volume expansions

Question 21

how can we use tpa for ICH treatment

Answer 21

wait for bleed to stabilise
minimally invasive procedure
administer tpa through catheter directly into haematoma to dissolve over 3 days