Hemorrhagic CVA - Lecture 11

Question 1

most common types

Answer 1

intracerebral hemorrhage

SAH

Question 2

intracerebral hemorrhage is d/t

Answer 2

HTN or cerebral amyloid angiopathy (CAA)

Question 3

what is CAA

Answer 3

harmless protein deposit that occurs with natural aging

Question 4

SAH is d/t

Answer 4

ruptured saccular aneurysm or AVM

Question 5

what else can hemorrhagic CVA be caused by

Answer 5

hyper anticoagulation

hemorrhage from brain tumor

trauma (such as TBI)

Question 6

incidence (age)

Answer 6

low under age of 45

dramatically increases after 65

exponential with further aging

Question 7

incidence (gender and race)

Answer 7

men > women

black > white

Question 8

other risk factors

Answer 8

CAA induced changes in the blood vessel of the elderly

thrombolytic therapy

long term anticoagulation use

drug and alc abuse

Question 9

pathogenesis

Answer 9

hyalinization of blood vessels

accumulation of fats and proteinaceous material

Question 10

hyalinization of blood vessels

Answer 10

replace of smooth muscle cells by collagen

changes to the permeability of the vessel wall

hardening and calcification of vessel wall

loss of elasticity

Question 11

accumulation of fats and proteinaceous material

Answer 11

leading to vessel walls that are prone to leak and rupture

Question 12

onset of ICH

Answer 12

typified by gradual and steady evolution that occurs over minutes, hours and days

Question 13

how many cases are sudden onset (ICH)

Answer 13

30%

Question 14

when do hemorrhagic CVA occur

Answer 14

during physical activity in the daytime

Question 15

how do hemorrhagic CVA present

Answer 15

severe HA

vomiting

seizures

Question 16

ICH cuase

Answer 16

bleeding from an arterial source into the brain parenchyma

Question 17

what are ICH often referred to as

Answer 17

intraparenchymal hemorrhage

Question 18

ICH is

Answer 18

most fatal of all CVA subtypes

Question 19

primary ICH is

Answer 19

spontaneous bleed

Question 20

Primary ICH d/t

Answer 20

microvascular dz associated w/ HTN and/or aging

Question 21

proposed scenario ICH

Answer 21

rupture of microaneurysms that burst as a result of HTN

Question 22

what are most frequently involved (primary ICH)

Answer 22

small penetrating arteries

Question 23

secondary ICH is NOT caused by

Answer 23

HTN

Question 24

what are secondary ICH d/t

Answer 24

trauma

impaired coagulation

tumors

toxins

Question 25

medical intervention ICH

Answer 25

lowering BP into normal range treatment of edema anticonvulsants

Question 26

lowering BP into normal range via

Answer 26

antihypertension meds

Question 27

treatment of edema

Answer 27

steroids mannitol glycerol-3

Question 28

anticonvulsants

Answer 28

if seizures are present

Question 29

what does an expanding lesion cause

Answer 29

significant increase in HTN

Question 30

why can an expanding lesion be fatal

Answer 30

compression of vital centers

Question 31

how does recovery occur

Answer 31

blood is reabsorbed before significant tissue destruction occurs

Question 32

subarachnoid hemorrhage

Answer 32

WORST HEADACHE OF LIFE WHOL

Question 33

what is a SAH

Answer 33

hemorrhaging in the subarachnoid space b/w arachnoid and pia mater

Question 34

SAH accounts for

Answer 34

6-8% of all CVA

Question 35

causes of SAH

Answer 35

trauma non-traumatic causes developmental defects neoplasm infection spontaneous

Question 36

non-traumatic causes

Answer 36

aneurysms and vascular malformations

Question 37

spontaneous

Answer 37

occur in normotensive persons

Question 38

aneurysms account for

Answer 38

90% of all SAHs

Question 39

what is an aneurysm

Answer 39

abnormal distension of the blood vessels at bifurcations caused by dz or weakening of the vessel walls

Question 40

aneurysm stimulus

Answer 40

elevated BP

Question 41

surgical interventions -->aneurysms

Answer 41

surgical clipping endovascular coiling

Question 42

surgical clipping

Answer 42

craniotomy "clipping" at neck

Question 43

endovascular coiling

Answer 43

catheter up femoral artery --> aorta --> aneurysm platinum coils --> thrombotic reaction --> blocks flow and prevents rupture

Question 44

most common sites of SAH

Answer 44

anterior communicating artery posterior communicating artery middle cerebral artery

Question 45

dangers of SAH

Answer 45

spewing of blood, under high pressure, into brain tissue susceptibility to re-rupture obstruction of the SA space blood in SA space

Question 46

what can obstruction of SA space lead to

Answer 46

hydrocephalus d/t CSF blockage

Question 47

blood in SA space

Answer 47

vasospasm inflammatory and fibrotic responses in the meninges

Question 48

vasospasm

Answer 48

resulting in ischemic infarction of the adjacent vessels

Question 49

secondary complications often prove

Answer 49

fatal

Question 50

what do SAH cause

Answer 50

extreme elevations in ICP fatal brain herniation

Question 51

extreme elevations in ICP d/t

Answer 51

obstruction of CSF and cerebral edema

Question 52

fatal brain herniation d/t

Answer 52

increased pressure and mass within cranial cavity

Question 53

primary sites of herniation

Answer 53

bones of the orbit and posterior fossa

Question 54

SAH can be

Answer 54

mild to severe

Question 55

mild SAH

Answer 55

often associated with stiff neck mild HA minimal focal neurologic signs confusion lasting for weeks

Question 56

moderate SAH

Answer 56

mild coma moderate to severe HA

Question 57

severe SAH

Answer 57

can be fatal severe HA decerebrate rigidity deep coma

Question 58

when is there significant chances of rebleeding

Answer 58

mod/severe