Hemorrhagic Stroke Flashcards
What are the names for Basal ganglia hemorrhages?
Putamenal, ganglionic hemmorhages
What are the predictors of deep intracerebral hemorrhage?
Hypertension, age, charcot-bouchard aneurysm, Asian, non-white
Where are Lobar intracerebral hemorrhages most commonly located?
Frontal>Parietal>Occipital>Temporal
What are the predictors of deep intracerebral hemorrhage?
Age, dementia, coagulation, White/Asian. Only 1/3 HTN
What can you do to stop hemorrhage growth?
Activated factor VII (thrombosis)
What are some causes of hemorrhage in young people?
Coagulation disorders, aneurysm, AVM, trauma (unrecognized), HTN, Venous system, Iatrogenic, Tumor, CNS vasculitis
What is a birefringent cerebral lobar hemorrhage
Congophilic amyloid angiopathy
What is the classic epidural hemorrhage?
Temporal bone fracture that tears the middle meningeal artery. Initial loss of consciousness then lucid interval.
What are the symptoms of Subarachnoid hemorrhage?
Instantaneous, worst headache
Why do we get aneurysms?
Arterial media goes away at branch points, allowing blood to create aneurysms in the circle of willis
What is the biggest risk factor for aneurysm?
Smoking (about five times more)
People with polycystic kidney disease also have higher risk
What is the classification system for subarachnoid hemorrhage
Hunt and Hess
What are AVM
Thought to be congenital, often found incidentally, but may present with seizure or hemorrhage
What are some complications associated with AVM?
Aneurysm and hemorrhage
What are risks for hemorrhage in AVM
Age, prior hemorrhage, deep location, exclusive deep drainage
Recognize the presentation of a ruptured intracranial aneurysm
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
Recognize the presentation of an intraparenchymal hemorrhage
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
Recognize the presentation of a subdural hemorrhage
Spontaneous subdural hemorrhage can be relatively asymptomatic.
Recognize the presentation of an epidural hemorrhage
Usually due to trauma to the middle meningeal artery. Rapidly progressive.
Discuss the basic principles of emergency treatment of hemorrhage
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.
Discuss how to modify metabolic, lifestyle, and structural risk factors for stroke
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
