Hemorrhagic Stroke Flashcards

1
Q

Intracranial hemorrhage

A
  • Intraparenchymal
  • Intraventricular
  • Subarachnoid

Trauma:
Epidural
Subdural

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2
Q

Intraparenchymal hemorrhage

?

A

Bleeding into parenchyma (intraaxial) , extending to ventricles

*more w/age

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3
Q

IPH cause

A

1) Uncontrolled HTN
2) amyloid angiopathy

Less common:
Infarction w/ hemorrhage, embolism, tumor, bleeding disorder, moyamoya, vasculitis

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4
Q

Rapidly progressing focal neuro

  • Vomiting,
  • systolic bp >220
  • severe headache
  • depressed mental status
  • MC asian countries
  • USA: blacks,hispanics

Presentation?

A

IPH Intraparenchymal hemorrhage

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5
Q

IPH

Dx/

A
*MC location (imaging):
Thalamus
Basal Ganglia
Pons
Cerebellum

*+ HTN
*amyloid angiopathy = lobar (surface)
Microhemorrages (MRI only)
Older patients

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6
Q

IPH management (acute)

A

Hemostasis/antiplatetelets,DVT prophylaxis

  • BP management
  • seizure prophylaxis
  • surgical interventions
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7
Q

IPH BP management

A

No evidence
BP 150-220 = lower to 140 can be beneficial
(10-20% reduction is good)

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8
Q

Seizure prophylaxis IPH

A
  • phenytoin MAY worsen outcomes

* Uncertain if seizure prophylaxis is good

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9
Q

Surgical interventions IPH

A

If hydrocephalus, brainstem compression, herniation

  • hydrocephalus - shunt
  • maybe helpful in lobar hemorrhage
  • unsure
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10
Q

Prognosis IPH

A
  • 1/2 die in first 2 days
  • Many do not achieve ind function
  • ICH score = 30 day survival
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11
Q

Subarachnoid Hemorrhage SAH

A
  • bleeding into subarachnoid space
  • MC all SAH hemorraghes=Trauma
  • MC spontaneous = aneurysmal
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12
Q

SAH

Non-traumatic Cause

A

1) ruptured aneurysm
2) Perimesencephalic pattern, vascular malformation, occult aneurysm

*severe TBI - SAH common complication

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13
Q

Aneurysmal Subarachnoid hemorrage

Who?

A

Rare
Blacks
Women
5th decade of life

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14
Q

Aneurysmal SAH

prognosis

A

Many die before hospital

1/2 die in 6 monts

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15
Q
  • non focal
  • HTN
  • Drowsy
  • occular - terson’s syndrome
  • cranial nerve palsy -CN3

Signs?

A

Aneurysmal SAH

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16
Q

Aneurysmal SAH

Dx

A

CT w/o contrast
Lumbar puncture
CTA/MRA/Angiogram

17
Q

Aneurysmal SAH

early manegement goals

A

Prevention of bleedin

Obliteration of aneurysm - clipping/coiling

18
Q

SAH

Complications

A

Cerebral vasospasms
Seizures
Hydrocephalus
Metabolic- Na changes

19
Q

Cerebral Vasospasm

SAH

A

Angiographic def = vasoconstriciton

INCOMPLETE CARD

  • risk 5-10 days after
  • peak risk 1 week
20
Q

Cerebral vasospasm - Aneurysmal SAH

Prevention

A
  • Nimpdipine

* for 21 days after

21
Q

Aneurysmal SAH

Cerebral vasospasm

Triple H

A

Hemodynamic augmentation

22
Q

Aneurysmal SAH

Gold standard Dx

A

Conventional Cerebral Angiogram

REAL LIFE = after Neg CT, neg LP

23
Q

Aneurysmal SAH

Location

A
  • MC saccular cerebral aneurysm - Anterior communicating Artery
  • 2nd = Posterior communicating artery
24
Q
  • acute - Worst headache of life
  • Sentinel bleed/warning sign - sometimes
  • N/V
  • Depressed mental status
  • Meningeal irritation/neck stiffness

S/s?

A

Aneurysmal SAH

25
Q

Aneurysmal SAH

Risk Factors

A
  • smoking
  • HTN
  • Heavy ETOH
  • Genetic predisposition for aneurysm