haemorrhagic stroke Flashcards
Define stroke
Stroke describes neurological deficit lasting longer than 24 hours due to vascular compromise
Sub divisions of haemorrhagic stroke
- primary intracerebral - bleeding within brain parenchyma
- subarachnoid- bleeding into subarachnoid space
- intraventricular - bleeding within the ventricles ; prematurity is a very strong risk factor
What are haemorrhagic strokes caused by
Ruptured blood vessel leading to reduced blood flow
Definition of intracerebral haemorrhage
Sudden bleeding into brain tissue due to rupture of blood vessels
intracerebral stroke is caused by?
NAME?
Subarachnoid haemorrhage is caused by
NAME?
what is SAH
intracranial haemorrhage characterised by blood within the subarachnoid space such as sylvian fissures and basal cisterns
most common locations for berry aneurysms
NAME?
two biggest risk factor for SAH
HT and SMOKING
Other risk factors for SAH
NAME?
what layers of the brain are classed as leptominenges
arachnoid
pia
what do SAH lead to
pool of blood under the arachnoid mater that increase intracranial pressure and prevents more blood from flowing into the brain
symptoms of a SAH
NAME?
What type of headache would occur in SAH
- severe sudden onset
- occipital
- ‘thunderclap’ headache
signs of a SAH
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
1st investigations for SAH
NAME?
Investigations to consider in SAH
NAME?
What would ct scan exhibit for SAH
NAME?
Management for SAH
- 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
if there are features of raised intracranial pressure then what is the management
- consider intubation with hyperventilation, head elevation (30°) and IV mannitol
conservative management of SAH
NAME?
complications of SAH
NAME?
What is triple H
NAME?
prognosis of SAH
At 6 months 25% dead 50% disabled
What is a primary intracerebral haemorrhage
bleeding within the cerebrum
What is a primary intracerebral haemorrhage?
Leakage of blood directly into brain tissue due to:
- Hypertension- weakens deep perforating blood vessels
- Amyloidosis
- Arteriovenous malformation
- Aneurysm rupture
causes of intracerebral H
NAME?
What is a secondary intracerebral hemorrhage?
due to trauma, warfarin or bleeding into a tumour are not classed as “strokes” but can cause similar symptoms
difference between an intraparenchymal haemorrhage and an intraventricular haemorrhage
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.
What is amyloidosis
dysfunctional brain proteins
A rupture can occur due to
NAME?
pathophysiology of an ICH
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.
clinical manifestations for ICH
- Headache
- Weakness
- Seizures
- Vomiting
- Reduced consciousness
Management for ICH
- Consider intubation, ventilation and ICU care if they have reduced consciousness
- Correct any clotting abnormality
- Correct severe hypertension but avoid hypotension
what drugs can relieve intracranial pressure
mannitol
What is a subdural haemorrhage
Bleeding below the dura mater due to a rupture of a bridging vein
location for subdural haemorrhage
between the dura and arachnoid
what would ct show for subdural
cresent/ banana shape and are not limited by the cranial sutures
RFs for subdural haemorrhage
Recent trauma - falls
advanced age
anticoagulant use
coagulopathy
epidemiology of SBH
NAME?
Rupture of bridging veins, usually caused by:
NAME?
timespan for subdural haemotoma
acute - symptoms in 2 days
subacute- 3-14 days
chronic- over 15
Haematoma and haemorrhage?
When there is active bleeding, it’s called a haemorrhage, and the collection of blood that results is called a haematoma.
Clinical presentation of subdural haematoma
NAME?
investigations for SBH
NAME?
signs of Intercranial pressure
Cushings triad- bradycardia, irregular respirations and a widened pulse pressure
Tx for SBH
NAME?
Define Extradural (Epidural) Haemorrhage
bleeding above the dura mater
Who is mostly affected by Extradural (Epidural) Haemorrhage
young adults
20-30
What is Extradural Haemorrhage usually caused by
trauma to middle meningeal artery due to damage to lateral pterygoid bone
Main risk factor for Extradural Haemorrhage
HEAD INJURY
Where do the frontal, parietal, temporal and sphenoid bones join
pterion
how does Extradural Haemorrhage present
- Initial event
- decrease gcs
- ICP signs elevated
- death from resp arrest
LUCID STAGE ‘ I FEEL FINE’
Rapid deterioration due to increase in ICP
Why would resp arrest occur in EH
Tonsillar herniation + caving of brain due to untreated ICP
What is the shape of a lesion for Extradural Haemorrhage
lemon shaped
management of Extradural Haemorrhage
NAME?
What is the glasgow coma scale based on
It is scored based on eyes, verbal response and motor response.
When would you consider securing an airway ( GCS)
- when someone has a score of 8/15
describe the GCS
- 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
treatment decisions for hyperacute stroke?
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?
