Hemorrhagic CVA - Lecture 11 Flashcards

1
Q

most common types

A

intracerebral hemorrhage

SAH

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2
Q

intracerebral hemorrhage is d/t

A

HTN or cerebral amyloid angiopathy (CAA)

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3
Q

what is CAA

A

harmless protein deposit that occurs with natural aging

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4
Q

SAH is d/t

A

ruptured saccular aneurysm or AVM

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5
Q

what else can hemorrhagic CVA be caused by

A

hyper anticoagulation

hemorrhage from brain tumor

trauma (such as TBI)

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6
Q

incidence (age)

A

low under age of 45

dramatically increases after 65

exponential with further aging

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7
Q

incidence (gender and race)

A

men > women

black > white

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8
Q

other risk factors

A

CAA induced changes in the blood vessel of the elderly

thrombolytic therapy

long term anticoagulation use

drug and alc abuse

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9
Q

pathogenesis

A

hyalinization of blood vessels

accumulation of fats and proteinaceous material

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10
Q

hyalinization of blood vessels

A

replace of smooth muscle cells by collagen

changes to the permeability of the vessel wall

hardening and calcification of vessel wall

loss of elasticity

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11
Q

accumulation of fats and proteinaceous material

A

leading to vessel walls that are prone to leak and rupture

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12
Q

onset of ICH

A

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

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13
Q

how many cases are sudden onset (ICH)

A

30%

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14
Q

when do hemorrhagic CVA occur

A

during physical activity in the daytime

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15
Q

how do hemorrhagic CVA present

A

severe HA

vomiting

seizures

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16
Q

ICH cuase

A

bleeding from an arterial source into the brain parenchyma

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17
Q

what are ICH often referred to as

A

intraparenchymal hemorrhage

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18
Q

ICH is

A

most fatal of all CVA subtypes

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19
Q

primary ICH is

A

spontaneous bleed

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20
Q

Primary ICH d/t

A

microvascular dz associated w/ HTN and/or aging

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21
Q

proposed scenario ICH

A

rupture of microaneurysms that burst as a result of HTN

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22
Q

what are most frequently involved (primary ICH)

A

small penetrating arteries

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23
Q

secondary ICH is NOT caused by

A

HTN

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24
Q

what are secondary ICH d/t

A

trauma

impaired coagulation

tumors

toxins

25
medical intervention ICH
lowering BP into normal range treatment of edema anticonvulsants
26
lowering BP into normal range via
antihypertension meds
27
treatment of edema
steroids mannitol glycerol-3
28
anticonvulsants
if seizures are present
29
what does an expanding lesion cause
significant increase in HTN
30
why can an expanding lesion be fatal
compression of vital centers
31
how does recovery occur
blood is reabsorbed before significant tissue destruction occurs
32
subarachnoid hemorrhage
WORST HEADACHE OF LIFE WHOL
33
what is a SAH
hemorrhaging in the subarachnoid space b/w arachnoid and pia mater
34
SAH accounts for
6-8% of all CVA
35
causes of SAH
trauma non-traumatic causes developmental defects neoplasm infection spontaneous
36
non-traumatic causes
aneurysms and vascular malformations
37
spontaneous
occur in normotensive persons
38
aneurysms account for
90% of all SAHs
39
what is an aneurysm
abnormal distension of the blood vessels at bifurcations caused by dz or weakening of the vessel walls
40
aneurysm stimulus
elevated BP
41
surgical interventions -->aneurysms
surgical clipping endovascular coiling
42
surgical clipping
craniotomy "clipping" at neck
43
endovascular coiling
catheter up femoral artery --> aorta --> aneurysm platinum coils --> thrombotic reaction --> blocks flow and prevents rupture
44
most common sites of SAH
anterior communicating artery posterior communicating artery middle cerebral artery
45
dangers of SAH
spewing of blood, under high pressure, into brain tissue susceptibility to re-rupture obstruction of the SA space blood in SA space
46
what can obstruction of SA space lead to
hydrocephalus d/t CSF blockage
47
blood in SA space
vasospasm inflammatory and fibrotic responses in the meninges
48
vasospasm
resulting in ischemic infarction of the adjacent vessels
49
secondary complications often prove
fatal
50
what do SAH cause
extreme elevations in ICP fatal brain herniation
51
extreme elevations in ICP d/t
obstruction of CSF and cerebral edema
52
fatal brain herniation d/t
increased pressure and mass within cranial cavity
53
primary sites of herniation
bones of the orbit and posterior fossa
54
SAH can be
mild to severe
55
mild SAH
often associated with stiff neck mild HA minimal focal neurologic signs confusion lasting for weeks
56
moderate SAH
mild coma moderate to severe HA
57
severe SAH
can be fatal severe HA decerebrate rigidity deep coma
58
when is there significant chances of rebleeding
mod/severe