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Neuro > Haemorrhagic stroke > Flashcards

Haemorrhagic stroke Flashcards

1
Q

What % of stokes are haemorrhagic?

A

10-20%

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2
Q

Order of intracranial bleeds

A

Extradural

Dural

Subdural

Arachnoid

Subarachnoid

Pia

Intracerebral

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3
Q

Shape of extradural haemorrhage?

A

Lemon (cranial sutures)

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4
Q

Shape of subdural haemorrhage?

A

Banana

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5
Q

GCS- 3 scores measured?

A

Eyes
Motor
Verbal

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6
Q

GCS- eyes scores

A

spontaneous- 4
speech-3
pain-2
none-1

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7
Q

GCS- verbal response scores

A

Orientated- 5
Confused conversation-4
Inappropriate words-3
Incomprehensible sounds-2
None-1

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8
Q

GCS- motor response scores

A

Obeys commands= 6
Localises pain=5
Withdraws from pain=4
Flexion= 3
Extension= 2
None=1

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9
Q

Cause of extradural?

A

Rupture of middle meningeal artery in temporal-parietal region (associated with fracture of temporal bone)

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10
Q

Cause of subdural?

A

Rupture of bridging veins

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11
Q

Cause of subarachnoid?

A

Ruptured cerebral aneurysm on circle of willis
Hypertension

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12
Q

Cause of intracerebral?

A

Spontaneous
Bleeding into an ischaemic infarct or tumour
Ruptured aneurysm

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13
Q

Extradural typical patient

A

Rugby lad
Blow to head
LOC then improved neuro sx then rapid decline over a few hours as haematoma gets big enough to compress intracranial contents

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14
Q

Subdural typical patient

A

Elderly or alcoholic (brain atrophy so vessels more likely to rupture)

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15
Q

Subarachnoid typical patient

A

Weightlifter, strenuous sex
Associated with anaemia and sickle cell anaemia

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16
Q

How does an intracerebral haemorrhage present?

A

bleeding into brain tissue so similar to an ischaemic stroke
Can be anywhere in the brain: cerebella, lobar, basal ganglia

17
Q

Management

A

Immediate head CT
Check FBC and clotting
Correct hypertension but avoid hypotension
Consider surgical intervention

18
Q

Presentation of SAH?

A

Thunderclap headache
Neck stiffness
Photophobia
Vision changes
Speech changes and weakness
Seizures
LOC

19
Q

Risk factors for SAH?

A

Hypertension
Alcohol
Cocaine
Smoking

20
Q

SAH associated with?

A

Sickle cell anaemia
Polycystic kidney disease
Connective tissue disorders
Neurofibromatosis

21
Q

What does a haemorrhagic stroke show up like on a head CT?

A

Hyperattenuation= white

22
Q

CT of a SAH?

A

White star shape- blood fills cisterns

23
Q

Other investigation for SAH?

A

LP–> shows xanthochromia (yellow CSF caused by bilirubin) and raised red cell count

Angiography to locate source of bleeding

24
Q

Management for SAH?

A

Surgery- clipping and coiling of blood vessels
Nimodipine- CCB to prevent vasospasm (stops ischaemia)
LP or a shunt to treat hydrocephalus

Neuro (10 decks)

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