Hemorrhagic Stroke Flashcards
Intracranial hemorrhage
- Intraparenchymal
- Intraventricular
- Subarachnoid
Trauma:
Epidural
Subdural
Intraparenchymal hemorrhage
?
Bleeding into parenchyma (intraaxial) , extending to ventricles
*more w/age
IPH cause
1) Uncontrolled HTN
2) amyloid angiopathy
Less common:
Infarction w/ hemorrhage, embolism, tumor, bleeding disorder, moyamoya, vasculitis
Rapidly progressing focal neuro
- Vomiting,
- systolic bp >220
- severe headache
- depressed mental status
- MC asian countries
- USA: blacks,hispanics
Presentation?
IPH Intraparenchymal hemorrhage
IPH
Dx/
*MC location (imaging): Thalamus Basal Ganglia Pons Cerebellum
*+ HTN
*amyloid angiopathy = lobar (surface)
Microhemorrages (MRI only)
Older patients
IPH management (acute)
Hemostasis/antiplatetelets,DVT prophylaxis
- BP management
- seizure prophylaxis
- surgical interventions
IPH BP management
No evidence
BP 150-220 = lower to 140 can be beneficial
(10-20% reduction is good)
Seizure prophylaxis IPH
- phenytoin MAY worsen outcomes
* Uncertain if seizure prophylaxis is good
Surgical interventions IPH
If hydrocephalus, brainstem compression, herniation
- hydrocephalus - shunt
- maybe helpful in lobar hemorrhage
- unsure
Prognosis IPH
- 1/2 die in first 2 days
- Many do not achieve ind function
- ICH score = 30 day survival
Subarachnoid Hemorrhage SAH
- bleeding into subarachnoid space
- MC all SAH hemorraghes=Trauma
- MC spontaneous = aneurysmal
SAH
Non-traumatic Cause
1) ruptured aneurysm
2) Perimesencephalic pattern, vascular malformation, occult aneurysm
*severe TBI - SAH common complication
Aneurysmal Subarachnoid hemorrage
Who?
Rare
Blacks
Women
5th decade of life
Aneurysmal SAH
prognosis
Many die before hospital
1/2 die in 6 monts
- non focal
- HTN
- Drowsy
- occular - terson’s syndrome
- cranial nerve palsy -CN3
Signs?
Aneurysmal SAH
Aneurysmal SAH
Dx
CT w/o contrast
Lumbar puncture
CTA/MRA/Angiogram
Aneurysmal SAH
early manegement goals
Prevention of bleedin
Obliteration of aneurysm - clipping/coiling
SAH
Complications
Cerebral vasospasms
Seizures
Hydrocephalus
Metabolic- Na changes
Cerebral Vasospasm
SAH
Angiographic def = vasoconstriciton
INCOMPLETE CARD
- risk 5-10 days after
- peak risk 1 week
Cerebral vasospasm - Aneurysmal SAH
Prevention
- Nimpdipine
* for 21 days after
Aneurysmal SAH
Cerebral vasospasm
Triple H
Hemodynamic augmentation
Aneurysmal SAH
Gold standard Dx
Conventional Cerebral Angiogram
REAL LIFE = after Neg CT, neg LP
Aneurysmal SAH
Location
- MC saccular cerebral aneurysm - Anterior communicating Artery
- 2nd = Posterior communicating artery
- acute - Worst headache of life
- Sentinel bleed/warning sign - sometimes
- N/V
- Depressed mental status
- Meningeal irritation/neck stiffness
S/s?
Aneurysmal SAH
Aneurysmal SAH
Risk Factors
- smoking
- HTN
- Heavy ETOH
- Genetic predisposition for aneurysm
