Haemorrhagic stroke Flashcards

1
Q

A haemorrhagic stroke is a f___ neurological deficit lasting 24+ hours with ______

A

focal, infarction

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2
Q

What percentage of strokes are haemorrhagic?

A

15%

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3
Q

What causes a haemorrhagic stroke?

A

Ruptures blood vessel
Trauma
Hypertension
Ruptured berry aneurysm

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4
Q

Typically haemorrhagic strokes are intracerebral or s_______

A

subarachnoid

(epidural and subdural are haemorrhages)

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5
Q

Haemorrhagic strokes can cause h____ in downstream tissue

A

hypoxia

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6
Q

What layer is directly under the skull?

A

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.

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7
Q

What layers does an extradural haematoma occur?

A

Between the skull and periosteal layer of dura mater

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8
Q

What blood vessel most commonly causes an extradural hematoma?

A

Middle meningeal artery, result of direct trauma.

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9
Q

What is directly under the meningeal layer of the dura mater?

A

Subdural space

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10
Q

What layer is under the subdural space?

A

Arachnoid mater (middle layer of meninges)
layers of connective tissue

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11
Q

What supplies the arachnoid mater?

A

It is avascular
Also doesn’t receive any innervation.

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12
Q

What are the small projections of the arachoid mater called?

A

Arachnoid granulations.
Up into subdural space, allows CSF to re-enter dural venous sinuses and circulate

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13
Q

What is directly under the arachnoid mater?

A

Subarachnoid space, contains CSF.

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14
Q

What is under the subarachnoid space?

A

Pia mater.
Very thin, follows gyri and fissures of the brain, tightly adhered to brain and spinal cord.
Highly vascularised

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15
Q

Where does a subdural haematoma form in?

A

In subdural space, between meningeal layer of dura mater and arachnoid mater.

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16
Q

What blood vessels commonly cause a subdural haematoma?

A

Damage to cerebral veins as they empty into the venous sinuses

17
Q

What is meningitis and what does it cause?

A

Inflammation of the meninges (dura, arachnoid and pia mater), commonly due to infection.

Immune response to infection causes cerebral oedema which raises ICP.

18
Q

What can ICP in the brain cause?

A

Cranial herniation and/or reduced cerebral perfusion (in combo with systemic hypotension)

Both complications of meningitis can rapidly result in death.

19
Q

What are risk factors for haemorrhagic stroke?

A

Male
Asian, African
Heavy alcohol use
Amphetamines
Cocaine abuse
Antithrombotic medications

20
Q

What are signs and symptoms of a haemorrhagic stroke?

A

Begin slowly, worsen gradually
Altered consciousness
Headache
Nausea
Vomiting
Unequal pupil size
Fever
Muscle weakness
Impaired vision
Slurred speech
Ataxia

21
Q

How do you diagnose a haemorrhagic stroke?

A

CT scan:
Hyperdense blood mass acutely
MRI

22
Q

How do you treat a haemorrhagic stroke?

A

Neurosurgery refferal
IV mannitol (for increased ICP)

23
Q

What prophylaxis is given for haemorrhagic stroke?

A

atorvastatin (lowers LDL)
Ramipril (ACE-i, antihypertensive)