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Haemorrhagic stroke Flashcards

1
Q

Define stroke

A

Stroke describes neurological deficit lasting longer than 24 hours due to vascular compromise

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2
Q

Sub divisions of haemorrhagic stroke

A
  • primary intracerebral - bleeding within brain parenchyma
  • subarachnoid- bleeding into subarachnoid space
  • intraventricular - bleeding within the ventricles ; prematurity is a very strong risk factor
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3
Q

What are haemorrhagic strokes caused by

A

Ruptured blood vessel leading to reduced blood flow

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4
Q

Definition of intracerebral haemorrhage

A

Sudden bleeding into brain tissue due to rupture of blood vessels

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5
Q

intracerebral stroke is caused by?

A
  • Trauma
  • Arteriovenous malformation
  • Cerebral amyloid
  • Hypertension
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6
Q

Subarachnoid haemorrhage is caused by

A
  • Trauma
  • Berry aneurysm
  • Arteriovenous malformation
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7
Q

what is SAH

A

intracranial haemorrhage characterised by blood within the subarachnoid space such as sylvian fissures and basal cisterns

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8
Q

most common locations for berry aneurysms

A
  • junction between the anterior communicating and anterior cerebral arteries
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9
Q

two biggest risk factor for SAH

A

HT and SMOKING

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10
Q

Other risk factors for SAH

A

-AGE
- fx
- pkd
-alcohol

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11
Q

what layers of the brain are classed as leptominenges

A

arachnoid
pia

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12
Q

what do SAH lead to

A

pool of blood under the arachnoid mater that increase intracranial pressure and prevents more blood from flowing into the brain

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13
Q

symptoms of a SAH

A
  • Headache
  • meningism
  • N/V
  • confusion and coma
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14
Q

What type of headache would occur in SAH

A
  • severe sudden onset
  • occipital
  • ‘thunderclap’ headache
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15
Q

signs of a SAH

A

3rd nerve palsy
- An aneurysm arising from the posterior communicating artery will press on the 3rd nerve, causing a palsy with afixed dilated pupil

6th nerve palsy
- a non specific sign which indicates raised intracranial pressure

  • reduced GCS
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16
Q

1st investigations for SAH

A
  • urgent non-contrast CT head
  • ECG
  • FBC
  • serum electrolytes
  • clotting profile
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17
Q

Investigations to consider in SAH

A
  • lumbar puncture
  • ct angiogram
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18
Q

What would ct scan exhibit for SAH

A
  • star shape
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19
Q

Management for SAH

A
  • Nimodipine 60mg 4 hourly upon diagnosis, to prevent vasospasm
  • intervention =first-line is endovascular coiling of the aneurysm by an interventional radiologist; second-line is surgical clipping via craniotomy
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20
Q

if there are features of raised intracranial pressure then what is the management

A
  • consider intubation with hyperventilation, head elevation (30°) and IV mannitol
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21
Q

conservative management of SAH

A
  • Bed rest
    -Antitussive agent and stool softeners: prevents straining and therefore reduce the risk of rebleeding
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22
Q

complications of SAH

A
  • rebleeding
  • vasospasm
  • Triple H - hyperventilation, hypervolaemia, hemodilution
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23
Q

What is triple H

A
  • hypertension
  • hypervolaemia
  • haemodilution
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24
Q

prognosis of SAH

A

At 6 months 25% dead 50% disabled

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25
Q

What is a primary intracerebral haemorrhage

A

bleeding within the cerebrum

26
Q

What is a primary intracerebral haemorrhage?

A

Leakage of blood directly into brain tissue due to:

  • Hypertension- weakens deep perforating blood vessels
  • Amyloidosis
  • Arteriovenous malformation
  • Aneurysm rupture
27
Q

causes of intracerebral H

A
  • Hypertension- weakens deep perforating blood vessels
  • Amyloidosis
  • Arteriovenous malformation
  • Aneurysm rupture
28
Q

What is a secondary intracerebral hemorrhage?

A

due to trauma, warfarin or bleeding into a tumour are not classed as “strokes” but can cause similar symptoms

29
Q

difference between an intraparenchymal haemorrhage and an intraventricular haemorrhage

A

just the brain tissue is called an intraparenchymal haemorrhage, whereas if the blood extends into the ventricles of the brain which store cerebrospinal fluid, it’s called an intraventricular haemorrhage.

30
Q

What is amyloidosis

A

dysfunctional brain proteins

31
Q

A rupture can occur due to

A
  • HTN
  • AV malformations
  • vasculitis
  • vascular tumors
32
Q

pathophysiology of an ICH

A

blood starts to spew out from a damaged blood vessel creating a pool of blood which increases pressure in the skull and puts direct pressure on nearby tissue cells and blood vessels.

33
Q

clinical manifestations for ICH

A
  • Headache
  • Weakness
  • Seizures
  • Vomiting
  • Reduced consciousness
34
Q

Management for ICH

A
  • Consider intubation, ventilation and ICU care if they have reduced consciousness
  • Correct any clotting abnormality
  • Correct severe hypertension but avoid hypotension
35
Q

what drugs can relieve intracranial pressure

A

mannitol

36
Q

What is a subdural haemorrhage

A

Bleeding below the dura mater due to a rupture of a bridging vein

37
Q

location for subdural haemorrhage

A

between the dura and arachnoid

38
Q

what would ct show for subdural

A

cresent/ banana shape and are not limited by the cranial sutures

39
Q

RFs for subdural haemorrhage

A

Recent trauma - falls
advanced age
anticoagulant use
coagulopathy

40
Q

epidemiology of SBH

A
  • elderly
  • alcoholics
41
Q

Rupture of bridging veins, usually caused by:

A
  • brain atrophy , age
  • alcohol abuse - walls of the veins will thin out
  • trauma/ injury
42
Q

timespan for subdural haemotoma

A

acute - symptoms in 2 days
subacute- 3-14 days
chronic- over 15

43
Q

Haematoma and haemorrhage?

A

When there is active bleeding, it’s called a haemorrhage, and the collection of blood that results is called a haematoma.

44
Q

Clinical presentation of subdural haematoma

A
  • reduced gcs
  • headache
  • vomiting
  • seizures
  • unsteadiness
45
Q

investigations for SBH

A
  • immediate ct head scan to establish diagnosis
46
Q

signs of Intercranial pressure

A

Cushings triad- bradycardia, irregular respirations and a widened pulse pressure

47
Q

Tx for SBH

A
  • SURGERY
  • burrhole and craniotomy( for large)
  • IV mannitol to decrease ICP
48
Q

Define Extradural (Epidural) Haemorrhage

A

bleeding above the dura mater

49
Q

Who is mostly affected by Extradural (Epidural) Haemorrhage

A

young adults
20-30

50
Q

What is Extradural Haemorrhage usually caused by

A

trauma to middle meningeal artery due to damage to lateral pterygoid bone

51
Q

Main risk factor for Extradural Haemorrhage

A

HEAD INJURY

52
Q

Where do the frontal, parietal, temporal and sphenoid bones join

A

pterion

53
Q

how does Extradural Haemorrhage present

A
  • Initial event
  • decrease gcs
  • ICP signs elevated
  • death from resp arrest

LUCID STAGE ‘ I FEEL FINE’

Rapid deterioration due to increase in ICP

54
Q

Why would resp arrest occur in EH

A

Tonsillar herniation + caving of brain due to untreated ICP

55
Q

What is the shape of a lesion for Extradural Haemorrhage

A

lemon shaped

56
Q

management of Extradural Haemorrhage

A
  • urgent surgery
  • mannitol IV
57
Q

What is the glasgow coma scale based on

A

It is scored based on eyes, verbal response and motor response.

58
Q

When would you consider securing an airway ( GCS)

A
  • when someone has a score of 8/15
59
Q

describe the GCS

A
  • out of 15 , minimum score is 3/15

eyes out of 4
verbal out of 5
motor out of 6

15= normal
8= comatose
3= unresponsive

60
Q

treatment decisions for hyperacute stroke?

A

Is the presentation compatible with stroke ?
Is it a bleed or an infarct?
Is this a case for thrombolysis or thrombectomy?
What are the benefits?
What are the risks ?
How can we prevent stroke complications?

Neuro (19 decks)

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