hemorrhagic stroke Flashcards
What percentage of strokes are caused by intracerebral hemorrhage?
10%
It is the second leading cause after ischemic strokes.
What are some risk factors for intracerebral hemorrhage?
- HTN
- Alcohol
- Age
- Smoking
- Illicit drugs
- Tumor
- Cerebral amyloid angiopathy
- Vascular malformation
- Coagulopathies
- Anticoagulation treatment
These factors increase the likelihood of hemorrhage.
What is the most common cause of intracerebral hemorrhage?
Hypertension
It primarily affects deep white matter regions such as BG, BS, thalamus, cerebellum, and pons.
What is hyaline arteriosclerosis also known as?
Lipohyalinosis
It contributes to the development of intracerebral hemorrhage.
What are Charcot-Bouchard microaneurysms associated with?
Intracerebral hemorrhage
These microaneurysms are small dilations of the small penetrating arteries.
What type of hemorrhage is associated with cerebral amyloid angiopathy?
Lobar hemorrhage
This condition is related to Alzheimer’s disease.
What is a significant risk factor related to cerebral amyloid angiopathy?
B-amyloid and apo E mutation
E4 allele is a risk factor, while E2 allele is protective.
What symptoms may present in a patient with intracerebral hemorrhage?
- Focal motor/sensory deficit
- Progressive worsening of symptoms
- Loss of consciousness
- Features of increased ICP
- Seizures
Symptoms can escalate as the hematoma expands.
What is the immediate imaging requirement for suspected intracerebral hemorrhage?
Non-contrast CT
This is mandatory for diagnosis.
What is the most important step in the treatment of intracerebral hemorrhage?
Control hypertension
Target systolic blood pressure should be between 140-160 mmHg.
What medications can be used for IV infusion to control hypertension in intracerebral hemorrhage?
- Labetalol
- Nicardipine (CCB)
These medications should be monitored during administration.
What methods can be used to decrease intracranial pressure (ICP)?
- Elevating head of bed
- Hyperventilation
- Mannitol
Hyperventilation is the fastest way to decrease ICP.
What should be administered for seizures in the case of intracerebral hemorrhage?
IV anti-epileptics
This is part of the management protocol.
What surgical intervention may be necessary in cases of large bleed, coma, brainstem compression, or hydrocephalus?
Neurosurgery
This is considered if conservative management fails.
What is recommended for VTE prophylaxis in intracerebral hemorrhage patients?
IPC (Intermittent Pneumatic Compression)
This helps prevent venous thromboembolism.
What percentage of strokes does subarachnoid hemorrhage (SAH) account for?
5%
SAH is the third cause of strokes.
What is the most common cause of subarachnoid hemorrhage?
Head injury (traumatic SAH)
In the absence of trauma, spontaneous SAH may occur.
What percentage of spontaneous SAH cases is due to the rupture of saccular berry aneurysms?
70%
Most commonly occurs at the Circle of Willis.
What are the common locations for saccular berry aneurysms?
- Anterior communicating artery
- Origin of the posterior communicating artery
These are common branching points.
What are some risk factors for the rupture of aneurysms?
- Smoking
- Family history
- Hypertension
- Alcohol
- Drugs
These factors increase the risk of aneurysm rupture.
What percentage of spontaneous SAH cases is due to congenital arteriovenous malformations (AVM)?
10%
AVMs are a lesser-known cause of SAH.
What is the risk of a first bleed in spontaneous SAH per year?
2-3%
The risk of rebleed is higher at 10% per year.
What are some other causes of subarachnoid hemorrhage besides aneurysm rupture?
- Pituitary apoplexy
- Arterial dissection
- Mycotic (infective) aneurysm
These are less common causes of SAH.
What is the typical presentation of subarachnoid hemorrhage?
- Abrupt onset of severe headache
- Meningeal irritation (neck stiffness, Kernig sign)
- Nausea and vomiting
- Sub-hyaloid hemorrhage
Headache is often described as the worst ever experienced.
What may accompany the headache in subarachnoid hemorrhage?
- Sentinel bleeding
- Worsening headache
- Brief loss of consciousness
- Seizures
These symptoms can indicate the severity of SAH.
What is the primary diagnostic tool for subarachnoid hemorrhage?
Non-contrast CT
Should be performed within 24 hours for best results.
What findings on lumbar puncture indicate subarachnoid hemorrhage?
- Increased opening pressure
- Red blood cells in CSF
- Xanthochromia (bilirubin in CSF)
These findings help confirm SAH when CT results are normal.
What is the main treatment for subarachnoid hemorrhage?
- Bed rest
- Analgesia
- Blood pressure control
- Nimodipine (CCB)
- Maintain euvolemia
These measures help manage symptoms and prevent complications.
What is the target systolic blood pressure for patients with subarachnoid hemorrhage?
Below 160 mmHg
This is crucial for managing blood pressure in SAH patients.
What is the only effective treatment to prevent rebleeding in subarachnoid hemorrhage?
Obliteration of aneurysm by surgical clipping or endovascular coiling
Best performed within 24 hours.
What are some complications associated with subarachnoid hemorrhage?
- Rebleeding (30%)
- Vasospasm and delayed cerebral ischemia
- Increased intracranial pressure (ICP)
- Hydrocephalus
- Hyponatremia
- Seizures
- Death
Management of these complications is crucial for patient outcomes.
What is the significance of a Glasgow Coma Scale (GCS) score greater than 12?
Most prognostic significance
GCS, along with age and amount of blood on CT, predicts outcomes.
What percentage of patients die suddenly or soon after a hemorrhage?
50%
The remaining patients may experience varying degrees of neurological deficits.
What is a subdural hematoma?
Bleeding between dura & arachnoid membranes due to tearing of bridging veins
It results in venous bleeding with a slow accumulation.
What is the primary cause of subdural hematoma?
Head trauma
Who is at higher risk for subdural hematoma?
Elderly & alcoholics
What are some risk factors for subdural hematoma?
- Previous head injury
- Use of anti-thrombotic medications
What are common symptoms of subdural hematoma?
- Headache
- Drowsiness
- Confusion
- Change in mental function
- Focal neuro signs or hemiparesis
- Coma
What does a CT scan of a subdural hematoma show?
Crescent shape hematoma (concave) that crosses sutures
What is the treatment for symptomatic subdural hematoma?
Neurosurgical evacuation
Can subdural hematomas regress spontaneously?
Yes
What is an epidural hematoma?
Bleeding between the skull and dura mater due to middle meningeal artery tear
What type of bleeding occurs in an epidural hematoma?
Arterial bleed
What is the typical presentation of an epidural hematoma?
Immediate loss of consciousness followed by a 24-hour lucid interval
What does a CT scan of an epidural hematoma show?
Lens shape (biconcave) that doesn’t cross sutures
What is the treatment for an epidural hematoma?
Emergent neurosurgical evacuation
What can happen if an epidural hematoma is not treated immediately?
Brain herniation & midline shift
