Hemorrhagic Stroke

Question 1

What are the names for Basal ganglia hemorrhages?

Answer 1

Putamenal, ganglionic hemmorhages

Question 2

What are the predictors of deep intracerebral hemorrhage?

Answer 2

Hypertension, age, charcot-bouchard aneurysm, Asian, non-white

Question 3

Where are Lobar intracerebral hemorrhages most commonly located?

Answer 3

Frontal>Parietal>Occipital>Temporal

Question 4

What are the predictors of deep intracerebral hemorrhage?

Answer 4

Age, dementia, coagulation, White/Asian. Only 1/3 HTN

Question 5

What can you do to stop hemorrhage growth?

Answer 5

Activated factor VII (thrombosis)

Question 6

What are some causes of hemorrhage in young people?

Answer 6

Coagulation disorders, aneurysm, AVM, trauma (unrecognized), HTN, Venous system, Iatrogenic, Tumor, CNS vasculitis

Question 7

What is a birefringent cerebral lobar hemorrhage

Answer 7

Congophilic amyloid angiopathy

Question 8

What is the classic epidural hemorrhage?

Answer 8

Temporal bone fracture that tears the middle meningeal artery. Initial loss of consciousness then lucid interval.

Question 9

What are the symptoms of Subarachnoid hemorrhage?

Answer 9

Instantaneous, worst headache

Question 10

Why do we get aneurysms?

Answer 10

Arterial media goes away at branch points, allowing blood to create aneurysms in the circle of willis

Question 11

What is the biggest risk factor for aneurysm?

Answer 11

Smoking (about five times more)

People with polycystic kidney disease also have higher risk

Question 12

What is the classification system for subarachnoid hemorrhage

Answer 12

Hunt and Hess

Question 13

What are AVM

Answer 13

Thought to be congenital, often found incidentally, but may present with seizure or hemorrhage

Question 14

What are some complications associated with AVM?

Answer 14

Aneurysm and hemorrhage

Question 15

What are risks for hemorrhage in AVM

Answer 15

Age, prior hemorrhage, deep location, exclusive deep drainage

Question 16

Recognize the presentation of a ruptured intracranial aneurysm

Answer 16

80% of non-traumatic subarachnoid hemorrhages are caused by burst aneurysms.
Subarachnoid hemorrhage: Explosion followed by severe headache. Cranial nerve palsy or hemiparesis may be present after ruptured intracranial aneurysm

Question 17

Recognize the presentation of an intraparenchymal hemorrhage

Answer 17

Often due to hypertension and age. Typically occur in basal ganglia, thalamus, pons, and cerebellar deep grey matter. In atypical locations such as deep white matter, may be due to AVM, aneurysms, vasculitis, bleeding disorders, or even hemorrhage into tumors. Amyloid angiopathies (amyloid deposition in the vessels) can lead to recurrent lobar hemorrhages causing progressive mental deterioration.
Intraparenchymal hemorrhage/hematoma: begins with mild h/a, deficit, some nausea, and over the next few hours decreased consciousness and hemiparesis that slowly morphs into hemiplegia

Question 18

Recognize the presentation of a subdural hemorrhage

Answer 18

Spontaneous subdural hemorrhage can be relatively asymptomatic.

Question 19

Recognize the presentation of an epidural hemorrhage

Answer 19

Usually due to trauma to the middle meningeal artery. Rapidly progressive.

Question 20

Discuss the basic principles of emergency treatment of hemorrhage

Answer 20

Immediate diagnosis. ICP monitoring, drainage device, reduce ICP with diuresis and decreased CO2, and surgical intervention if necessary. In patients with subarachnoid hemorrhage, they almost always require physical intervention, so put them on nimodipine and statins to reduce vasospasm
Surgical therapy includes: for intracranial hemorrhage- removal or securing of intracranial aneurysms or AVMs and revascularization procedures
for intraparenchymal hemorrhages- drainage of hemorrhage, treatment of hydrocephalus, and placement of ICP monitor.

Question 21

Discuss how to modify metabolic, lifestyle, and structural risk factors for stroke

Answer 21

1) Do not over-anticoagulate!
2) Helmets…..
3) Suspect Aneurysms (especiall those over 7-10 mm)
4) Quit Smoking
5) General treatments for ischemic risk reduction likely help hemorrhage. Hypertension is a particular concern.
6) Use rational dosing of Anti-platelets