Haemorrhagic stroke Flashcards
A haemorrhagic stroke is a f___ neurological deficit lasting 24+ hours with ______
focal, infarction
What percentage of strokes are haemorrhagic?
15%
What causes a haemorrhagic stroke?
Ruptures blood vessel
Trauma
Hypertension
Ruptured berry aneurysm
Typically haemorrhagic strokes are intracerebral or s_______
subarachnoid
(epidural and subdural are haemorrhages)
Haemorrhagic strokes can cause h____ in downstream tissue
hypoxia
What layer is directly under the skull?
Dura mater (then arachnoid mater, then pia mater)
Made of 2 layers with dural venous sinuses between.
Outer periosteal layer, dural venous sinus, meningeal layer.
What layers does an extradural haematoma occur?
Between the skull and periosteal layer of dura mater
What blood vessel most commonly causes an extradural hematoma?
Middle meningeal artery, result of direct trauma.
What is directly under the meningeal layer of the dura mater?
Subdural space
What layer is under the subdural space?
Arachnoid mater (middle layer of meninges)
layers of connective tissue
What supplies the arachnoid mater?
It is avascular
Also doesn’t receive any innervation.
What are the small projections of the arachoid mater called?
Arachnoid granulations.
Up into subdural space, allows CSF to re-enter dural venous sinuses and circulate
What is directly under the arachnoid mater?
Subarachnoid space, contains CSF.
What is under the subarachnoid space?
Pia mater.
Very thin, follows gyri and fissures of the brain, tightly adhered to brain and spinal cord.
Highly vascularised
Where does a subdural haematoma form in?
In subdural space, between meningeal layer of dura mater and arachnoid mater.
What blood vessels commonly cause a subdural haematoma?
Damage to cerebral veins as they empty into the venous sinuses
What is meningitis and what does it cause?
Inflammation of the meninges (dura, arachnoid and pia mater), commonly due to infection.
Immune response to infection causes cerebral oedema which raises ICP.
What can ICP in the brain cause?
Cranial herniation and/or reduced cerebral perfusion (in combo with systemic hypotension)
Both complications of meningitis can rapidly result in death.
What are risk factors for haemorrhagic stroke?
Male
Asian, African
Heavy alcohol use
Amphetamines
Cocaine abuse
Antithrombotic medications
What are signs and symptoms of a haemorrhagic stroke?
Begin slowly, worsen gradually
Altered consciousness
Headache
Nausea
Vomiting
Unequal pupil size
Fever
Muscle weakness
Impaired vision
Slurred speech
Ataxia
How do you diagnose a haemorrhagic stroke?
CT scan:
Hyperdense blood mass acutely
MRI
How do you treat a haemorrhagic stroke?
Neurosurgery refferal
IV mannitol (for increased ICP)
What prophylaxis is given for haemorrhagic stroke?
atorvastatin (lowers LDL)
Ramipril (ACE-i, antihypertensive)
