ICH - Neuro medi

Question 1

Subarachnoid hemorrhages normally occur in what age?

Answer 1

mean onset is mid-50s

Question 2

Epidural hemorrhage is usually rupture of what artery?

Answer 2

middle meningeal artery

Question 3

What is usually post traumatic s/p fall in elderly pt causing rupture of bridging veins?

Answer 3

subdural hemorrhage

Question 4

Intraparenchymal hemorrhage is a/w

Answer 4

HTN or tumor

Question 5

Subarachnoid hemorrhage is a/w

Answer 5

trauma or aneurysm

Question 6

head trauma with brief LOC, lucid interval, then obtunded state; HA

On exam this pt has CL hemiparesis and ipsilateral pupil dialtion (anisocoria).

dx?

Answer 6

epidural hematoma

Question 7

How would you treat a subdural hematoma?

Answer 7

burr holes and drain if progressively worsening

Question 8

What does the FUNC score do?

When is it supposed to be used?

Answer 8

estimates the likelihood of functional independence 90 days after a diagnosis of ICH

used when the dx of ICH is made

Question 9

Score of 0-4 on the FUNC scale means

Answer 9

will have independence at 90 days out

Question 10

With scoring systems for brain traumas, what is one thing none of them do?

Answer 10

No score determines what you should do next

Question 11

A subarachnoid hemorrhage on imaging will show what classically?

Answer 11

star shape

Question 12

Who has a 5x increased risk of hemorrhagic stroke?

Answer 12

hypertensive vasculopathy pt

Question 13

What is the MC non-traumatic cause of lobar ICH in elderly?

Answer 13

cerebral amyloid angiopathy

Question 14

How much does smoking increase risk of ICH?

Answer 14

1.5 to 2.5x

Question 15

a midline shift means altered thalami, which probably means..

Answer 15

altered consciousness

Question 16

What is the common site of primary brain hemorrhage? What are ssx of disease here?

Answer 16

basal ganglia

CL hemiparesis, sensory loss, CL conjugate gaze paresis

Question 17

Most unruptured aneurysms are found where?

Answer 17

anterior circulation

Question 18

What aneurysm location has the highest risk of rupturing?

Answer 18

posterior or PCOM

Question 19

What presents with ‘worst headache ever’

Answer 19

SAH

Question 20

What is the Hunt Hess Grade?

Answer 20

Clinical survival scale

• Grade 1
  
  • asymptomatic
• grade 2
  
  • moderate to severe HA, nuchal rigidity, no neuro deficit except CN palsy
• grade 3
  
  • drowsy, minimal neuro deficit
• grade 4
  
  • stuporous, moderate to severe hemiparesis, possible early decerebrate rigidity and vegetative disturbances
• grade 5
  
  • deep coma, decerebrate, moribund

Question 21

What is the radiographic spasm risk scale?

Answer 21

Modified Fisher Scale

• MC complication of SAH is vasospasm (7-10 days sp)
• predicted by severity of blood on scan
• TCDs screen daily for vasospasm

Question 22

SAH is mostly diagnosed in the first 12 hours via CT, but if CT is negative, how can I dx SAH?

Answer 22

LP - presence of xanthochromia on CSF - nondiluting blood

absent after 14 days

Question 23

How do I treat SAH?

Answer 23

prevent re-bleeding (highest risk first 6 hours)

prevent vasospasm using nimodipine in all pts

endovascular coiling> surgical clipping of ruptured aneurysm

MAINTAIN EUVOLEMIA

Question 24

What three things can I fix to prevent poor outcome in my critical care brain injury pt?

Answer 24

fever, anemia, and hyperglycemia

Question 25

What complication can happen in most brain injuries? How do we tx this?

Answer 25

hypotonic hyponatremia

mannitol

Question 26

Should you ever give prophylatics for seizure med s/p brain injury

Answer 26

no

Question 27

cavernous malformations often present with…

What will this look like on imaging?

Answer 27

seizure or brain hemorrhage

popcorn or mulberry appearance

Question 28

What has dramatically helped reduce MM in SAH and ICH?

Answer 28

early surgery and optimal critical care management