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Neuro > Hemorrhage > Flashcards

Hemorrhage Flashcards

1
Q

extravasation of blood into subarachnoid space, particulary of basal cisterns and into cerebral spinal fluid pathways

A

subarachnoid hemorrhage

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2
Q

most subarachnoid hemorrhages due to what? can also be from what?

A

head trauma

spontaneous (intracranial saccular aneurysms)

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3
Q

what commonly appears in SAH?

A

AV malformations

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4
Q

some RFs of SAH?

A

intracranial aneurysms associated with coarctation of aorta
AV malformaition
polycystic dx of kidneys
fibromuscular dysplasia do renal arteries
HTN

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5
Q

s/s of SAH?

A

abrupt HA “worst HA of life”
maybe LOC
maybe hemiparesis or dilated pupil

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6
Q

drug for SAH?

A

Nimodipine (pevents cerebral vasospasm)

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7
Q

surgery for SAH is done to what?

A

eliminate source of hemorrhage, obliterate aneurysm, fluid, HTN therapy, shunting for hydrpcephalus, AV malformation obliteration, radiosurgery for deep AV malfor

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8
Q

pts with SAH die from what?

A

aneurysm (2ndary to cerebral vasospasm)

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9
Q

90% of these are caused by head trauma with a skull fracture that crosses a portion of the middle meningeal artery or vein?

A

epidural hemorrhage

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10
Q

the middle meningeal artery is torn how often in epidural hemorrhage?

A

60% of the time

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11
Q

classic problem with epidural hemorrhage?

A

pt falls and hits head, LOC, pts wakes up (EDH is expanding and increasing intracranial pressure), pts LOC again and dies from herniation

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12
Q

Cushings Triad?

A

systemic HTN
bradycardia
Respiratory depression

(this occurs when cerebral perfusion is compromised by increased intracranial pressure)

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13
Q

tx of epidural hemorrhage?

A

stabilization
evacuation and control of hemorrhage
embolization and observation

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14
Q

this can lead to stroke, more likely to result in death than ischemic stroke or subarachnoid hemorrhage, when accompanied with edema it may disrupt or compress adjacent brain tissue leading to neurological dysfunction

A

ICH (intracerebral hemorrhage)

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15
Q

causes of ICH:

A 
HTN
autoregulatroy dysfunction with excessive cerebral blood flow 
aneurysm or AVM
arteriopathy 
altered hemostasis
hemorrhagic necrosis
venous outflow obstruction 
nonpenetrating/penetrating cranial trauma
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16
Q

ICH s/s?

A

alteration in level of consciousness

N/V, HA, seizures, focal neurological deficits

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17
Q

Labs for ICH?

A

CBC/platelets
PT/PTT
CMP
Toxicology/serum alcohol

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18
Q

tx of ICH:

A

slowly lower BP to MAP less than 130mmHg

stabilize vital signs and get emergent CT

use normotonic fluids

avoid hyperthermia

correct coagulopahty with FFP, vit K, protamine, platelet transfusions

fosphenytoin for seizures or lovar hemorrhage

intubate and hyperventiliate if ICP increased (mannitol)

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19
Q

ICH prognosis:

good or bad?

larger hematomas

lobar hemmorhage

significant volume of intraventricular blood

hydrocephalus

A

bad

better than deep hemorrhage

bad
bad

20
Q

labetalol:

lowers what?

A

BP

21
Q

nicardipine:

A

CCB

22
Q

mannitol:

reduces what?

A

reduces cerebral edema with help of osmotic forces, resulting in reflex vasoconstrictio and lowering of ICP

23
Q

Fosphenytoin:

A

stabilizes neuronal membranes and decreases seizure activity

24
Q

Phytonadione/vit K:

A

promotes hepatic synthesis of clotting factors that inhibit warfarin effects

25
Q

protamine:

A

forms a salt with heparin and neutralizes its effects

26
Q

Famotidine:

A

H2 blocker (reduces gastric acid)

27
Q

rapidly clotting blood collection below the inner layer of the dura but external to the brain and arachnoid membrane (subacute and chronic phases)

A

subdural hematoma

28
Q

acute SDH:

what kind of pressure venous bleeding?

cerebral injury results from what?

A

low

direct pressure, increased ICP, intraparenchymal insults

29
Q

SDH:

in the subacute phase, the clotted blood does what?

A

liquefies

30
Q

SDH:

in the chronic phase, cellular elements have disintegrated and what remains in the subdural space?

A

collection of serous fluid

31
Q

SDH frequency is related to what?

A

incidence of blunt trauma

32
Q

SDH more common in who and why?

A

elderly, more predisposed to cerebral atrophy, less resilient bridging veins that can be damaged more easily

33
Q

bilateral SDH are more common in who?

intrhemispheric SDHs are associated with what?

A

infants (lack of adhesions)

child abuse

34
Q

simple SDH means there is no what?

complicated means there is what?

A

parenchymal injury (20% mortality)

parenchymal injury (50% mortality)

35
Q

hx of SDH:

acute:
chronic:

A

blunt head trauma

1/2 cases have no head trauma, progressive s/s

36
Q

any what should heighten suspicion of SDH:

A

coagulopathy

also hemophiliacs, alcoholics

37
Q

on PE SDH:

A

focal neurological signs following blunt trauma, signs of external trauma, abnormal mental status

38
Q

what is seen in acute/subacute SDH, what is needed for atleast 1 year?

A

sig neurological disability/impairment of function, seizure prophylaxis

39
Q

Chronic SDH:

mortaility is decreased, most pts resume functional status, what can reoccur?

A

hematoma, infx, seizures

40
Q

defects of circulatory system that are generally believed to arise during embryonic/fetal development or soon after birth, snarled tangles of arteries/veins

A

AV malformations

41
Q

s/s of AVM:

A

HA with no pattern, seizures, weakness, paresthesias, paralysis, focal finding, bruit

42
Q

tests for AVM:

A

CTA, MRA, Arteriogram

43
Q

tx for AVM:

A

conventional surgery, endvascualr embolization, radiosurgery

44
Q

saccular (berry) aneurysm:

A

rounded/pouch like sac of blood attahced by a neck or stem to an artery or branch of blood vessel

45
Q

lateral aneurysm:

A

bulge on one wall of blood vessel

46
Q

fusiform aneurysm:

A

formed by the widening along all walls of the vessel

47
Q

aneurysms are usually what? tx options?

A

asymptomatic, same as AVM

Neuro (6 decks)

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