Hemorrhagic Stroke Flashcards
What is are two debilitating forms of hemorrhagic stroke
Subarachnoid hemorrhage (SAH): Extravastion (leakage) of blood in the subarachnoid space, Intracerebral hemorrhage (ICH): bleeding into the parenchyma
What are aneurysms, where do they occur to cause hemorrhagic stroke
weakening of an artery wall that leads to a bulge distention, biforcations of an artery
T/F: Most strokes are ischemic and hemmorrhagic stroke occurs only 13% percent of the time. Most hemorrhagic strokes are ICH but SAH is associated with higher mortalities
True
What is a difference in cause of SAH compared to ICH
Trauma is cause in SAH while ICH can be caused by a spontaneous small vessel rupture
What are causes of hemorrhagic stroke that is common between both types
Rupture of aneurysm, arteriovenous malformations, neoplasm, coagulopathy
What are modifiable risk factors acute SAH, ICH
Hypertension, smoking, alcohol abuse, cocaine use/ same while including anticoagulation
Whant is used to diagnosis the type of stroke, what identifies the source of the bleeding
Computerized tomography (CT) scan,k cerebral aniography
What are the two management options of aSAH
Surgical intervention and medical management
When should surgical intervention be done to treat a aSAH, what are they
less than 3 days post-bleed/ crainiotomy for cliiping or percutaneous transluminal aniographic placement of glue
What should the blood pressure be before surgical procedure, what agents can be given
Nitroprusside, labetalol, nicardipine
What drug is indicated for aSAH, what is the dose and how long is it given
Nimodipine, 60 mg by mouth or nasal gastic tube every 4 hours for 21 days (can be given 30 mg every 2 hours if hypotensive)
T/f: Nimodipine is given in aSAH to lower the blood pressure in the brain that caused the aneurysym
False: Nimodipine is given for aSAH because it decreases the neurological deficits associated with vasospasms due to ischemia after aSAH
What other therapies should be given to a patient who had aSAH
Stool softner, DVT prophylaxis (Heparin 5000 units BID), antiemetics (N +V drugs), H2RAs and PPIs, fluids to keep the patient euvolemic
If a patient comes in with a ICH and they are takeing warfarin what should be given to bind it, when and what should be checked to see if therapy is working
Phytonadione AND KCentra, recheck INR in 30 mins and every 6 to 8 hours for next 24-48 hours
What is KCentra contraindicated in
Disseminated intravascular coagulation and Heparin Induced Thrombocytopenia
When is the risk of re-hemmorhage greatest
Within the first 6 hours
If a patient comes in with a ICH and they are taking dabigatran what should be given to bind it, alternatives
Praxbind (monoclonal antibody fragment), FEIBA or Kcentra
If a patient comes in with a ICH and they are taking rivaroxaban/apixaban/edoxaban what should be given to bind it, what are the limitations
Andexanet alfa/ return of anticoagulation effect after infusion,cost
What should the blood pressure management be for a patient who has ICH
If SBP is 150-220 mmHg and without contraindication to acute management acute lowering to 140 mm hg is appropiate, greater than 220 aggressive reduction with continous infusion is considered
