ICH in Young Adults and Pediatrics Flashcards
What is the most common cause of spontaneous ICH in young adults?
● A. Ruptured AVM
● B. Arterial hypertension
● C. Ruptured saccular aneurysm
● D. Sympathomimetic drug abuse
● E. Tumor
A. Ruptured AVM
Intracerebral hemorrhage of the newborn occurs primarily in the premature infants. Alternate terms for this include subependymal hemorrhage, germinal matrix hemorrhage, and periventricular intraventricular hemorrhage. Intraventricular hemorrhage arises from extension of subependymal hemorrhage through ependymal lining of ventricles and occurs in how many cases of subependymal hemorrhage?
● A. 50%
● B. 60%
● C. 70%
● D. 80%
● E. 90%
D. 80%
The metabolically active germinal matrix is susceptible to hypotension and hypoperfusion which can lead to infarction. The germinal matrix is a valuable watershed zone which is supplied by which artery?
● A. Heubner’s artery from anterior cerebral artery
● B. Terminal branches of the lateral striate arteries from the middle cerebral artery
● C. Anterior choroidal artery from the internal carotid or middle cerebral artery
● D. All of the above
D. All of the above
What is the pathogenesis of periventricular intraventricular hemorrhage in the preterm infant?
● A. Postnatal hypoxia due to respiratory distress syndrome related to hyaline membrane disease, pneumothorax, or anemia can deprive the metabolically active germinal matrix of oxygen. This ischemia makes them vulnerable to infarction and rupture
● B. Hypercapnia maximally dilates the thin-walled vessels of the germinal matrix. If this is followed by sudden increase in perfusion this can lead to rupture of vessels
● C. Increased venous pressure from any cause like labor or positive pressure ventilation can lead to hemorrhage in germinal matrix
● D. In dehydration followed by rapid resuscitation with hyperosmolar solutions with associated increase in systemic blood pressure, the germinal matrix is at risk of hemorrhage
● E. All of the above
E. All of the above
Which of the following are risk factors for periventricular intraventricular hemorrhage in premature infants?
● A. Those associated primarily with increased CBF or CPP
● B. Younger gestational age and low birth weight
● C. Acute amnionitis and failure to give antenatal steroids
● D. APGARs score less than 4 at 2 minutes and less than 8 at 5 minutes
● E. Use of recreational drugs by the mother or maternal aspirin use
● F. Smoking by the mother
● G. Acidosis and coagulopathies
F. Smoking by the mother
Which of the following are the grades of subependymal hemorrhage?
● A. Grade 1 is subependymal hemorrhage
● B. Grade 2 is IVH without ventricular dilatation
● C. Grade 3 is IVH with ventricular dilatation
● D. Grade 4 is IVH with parenchymal hemorrhage
● E. All of the above
E. All of the above
What can be the steps for prevention of periventricular intraventricular hemorrhage?
● A. Good prenatal care and avoiding preterm delivery with antenatal steroids
● B. Indomethacin and antenatal vitamin K given IM more than 4 hours prior to delivery
● C. Sluicing umbilical cord and delaying umbilical cord clamping by 30 to 120 seconds in premature infants increased hematocrit and decreased PIVH in 5 of 7 studies
● D. Using surfactant
● E. All of the above
E. All of the above
Following are the pathophysiologic effects of periventricular intraventricular hemorrhage (PIVH) except?
● A. Destruction of germinal matrix and direct injury to neural tissue from hematoma
● B. Reduction of CBF in the whole brain due to elevated ICP
● C. Decreased CPP leads to periventricular leukomalacia and cerebral infarction
● D. Injury to brain stem
● E. Periventricular hemorrhagic infarction, hydrocephalus, and seizures
D. Injury to brain stem
What is the indication of surgical intervention in a patient with periventricular intraventricular hemorrhage (PIVH)?
● A. Progressive ventriculomegaly
● B. Periventricular hemorrhage
● C. Progressive ventriculomegaly with the OFC crossing percentile curves and clinical evidence of increased ICP
● D. Progressive ventriculomegaly with OFC crossing percentile curves without clinical evidence of increased ICP
● E. None of the above
C. Progressive ventriculomegaly with the OFC crossing percentile curves and clinical evidence of increased ICP
What are the indications and requirements of insertion of VP shunt or conversion of sub Q reservoir to VP shunt?
● A. Symptomatic hydrocephalus or progressive ventriculomegaly
● B. Infant is extubated (and thus off ventilator)
● C. Infant weight more than or equal to 2,000 g
● D. CSF protein ideally less than 100 mg/dL
● E. No evidence of NEC
● F. All of the above
F. All of the above
What is the most common cause of spontaneous ICH in young adults?
● A. Ruptured AVM
● B. Arterial hypertension
● C. Ruptured saccular aneurysm
● D. Sympathomimetic drug abuse
● E. Tumor
A. Ruptured AVM
What is the site of hemorrhage at > 29-week gestational age?
● A. Head of caudate nucleus
● B. Lentiform nucleus
● C. Intraventricular
● D. Cerebellar vermis
● E. Lobar
A. Head of caudate nucleus
Risk factors for periventricular intraventricular hemorrhage (PIVH) do not include which of the following?
● A. Blood pressure fluctuations
● B. Younger gestational age (GA)
● C. Low birth weight
● D. Acute amnionitis
● E. Antenatal steroids
E. Antenatal steroids
Regarding ICH in newborns, an intraventricular hemorrhage with ventricular dilation, what is the subependymal hemorrhage grade?
● A. 1
● B. 2
● C. 3
● D. 4
● E. 5
C. 3
Post periventricular intraventricular hemorrhage (PIVH) hydrocephalus usually occurs for how long after the hemorrhage?
● A. 1 to 3 weeks
● B. 3 days
● C. 5 days
● D. 3 to 5 weeks
● E. 48 hours
A. 1 to 3 weeks
