Hemorrhagic Strokes

Question 1

What type of hemorrhagic stroke has symptoms such as:
Sudden onset of HA or LOC
Vomiting
Seizures
Nuchal Rigidity

Answer 1

Intracerebral Hemorrhage

Question 2

Where is the most common location of an ICH?

Answer 2

Putamen most common

Can also occur in thalamus, pons, cerebellum and cerebrum

Question 3

What is a common cause of ICH?

Answer 3

Chronic Hypertension

Question 4

What is the common cause for a Subarachnoid Hemorrhage?

Answer 4

Due to a ruptured saccular arterial aneurysm.

Saccular aneurysms = berry aneurysms

Question 5

90 to 95% of saccular aneurysms occur where in the Circle of Willis?

Answer 5

Anterior part

Question 6

What size are saccular aneurysms more likely to rupture?

Answer 6

10mm or larger

Question 7

When does a saccular aneurysms usually rupture? Active or Alseep?

Answer 7

Active

Question 8

What is the peak age for aneurysm to rupture?

Answer 8

fifth to sixth decade

Question 9

Saccular aneurysms are usually asymptomatic. However, what is one common clinical presentation seen?

Answer 9

Compression of Cranial Nerve 3

Question 10

What are the signs of Cranial Nerve 3 compression?

Answer 10

Mydriasis (dilated pupil)
Deviation of ipsilateral eye to lateral side (because of unopposed action of lateral rectus muscle)
Ptosis (drooping eyelid)

Question 11

What are the symptoms of a subarachnoid hemorrhage?

Answer 11

Worst HA of their life
(this is due to the blood irritating)

Question 12

What is the % risk of mortality of a Subarachanoid hemorrhage in the first 24hours?

Answer 12

25%

Question 13

What is the % risk of re-bleeding with Subarachamoid hemorrhage?

Answer 13

30%

Question 14

What is a common complication with Subarachnoid hemorrhages in the acute setting and how to treat it?

Answer 14

Vasospasm (due to presence of blood breakdown products on the subarachnoid space acting in the adventitia of the arteries.

Medication: Nimodipine (calcium channel blocker)

Question 15

What is the term that consists of a tangled mass of dilated vessels that forms an abnormal communication between the arterial and venous systems?

Answer 15

AVM: Arteriovenous Malformations

Question 16

Are AVMs low pressure or high pressure systems?

Answer 16

Low pressure systems

The larger the shunt, the lower the interior pressure. So if you have a large shunt, there would need to be an occlusion, to increase pressure to cause hemorrhage.

Question 17

Are hemorrhages from AVMs usually due from small or large AVMs?

Answer 17

Small, smaller have increase pressure due to increase resistance

Question 18

When do AVMs originate?

Answer 18

In fetal life. They are congenital

Question 19

Clinical Presentation of an AVM rupture?

Answer 19

Hemorrhage on imaging