Intracerebral Hemorrhage

Question 1

Cerebrovascular disease includes what 3 problems

Answer 1

Ischemic stroke
Hemorrhagic stroke
Vascular malformations

Question 2

Intracerebral vs intracranial hemorrhage

Answer 2

Intracerebral = in the brain (subarachnoid, intraparenchymal, intraventricular)
Intracranial = in the skull (the above, plus epidural and subdural)

Question 3

What is the most common cause of bleeding in the brain?

Answer 3

Hypertension

Causes microaneurysms that can burst

Question 4

Spot sign

Answer 4

On a contrast CT scan

Site of active bleeding

Question 5

Amyloid angiopathy

Answer 5

Deposition of beta amyloid in the vessel wall (wall becomes more fragile and can rupture)
Lobar hemorrhages (big bleeds, right to the surface of the brain)
Typically in the elderly
Common in Down’s syndrome

Question 6

Management steps for intracerebral hemorrhage

Answer 6

ABC's
Neuro ICU
Control BP
Reverse anticoagulation
\+/- surgical evacuation
\+/- treat hydrocephalus

Question 7

Why is BP high in ICH?

Answer 7

The ICP is high because of the blood, so BP needs to be high in order to get enough perfusion

Question 8

2 types of aneurysms

Answer 8

Saccular (balloon like expansion)

Fusiform (sausage like expansion of the vessel wall)

Question 9

Most common cause of subarachnoid hemorrhage

Answer 9

Aneurysms
Typically at branch points
Cause arterial weakening

Question 10

Why are cerebral arteries more prone to forming aneurysms?

Answer 10

Thinner intima
Only 1 elastic layer (most arteries have 2)
Gaps in the media and the elastic membrane at bifurcations

Question 11

How can an ischemic stroke turn into a hemorrhagic stroke?

Answer 11

During the ischemic stroke, the endothelial cells are starved of oxygen and become weakened
When you re-open the artery, the blood flow can cause a rupture of the fragile vessels
The tight junctions had been loosened and cell membrane potentials lost

Question 12

Clinical presentation of a SAH?

Answer 12

Sudden, severe headache
Nausea
Photophobia
Loss or alteration of consciousness
Focal neurological deficits
Sudden death (from really high ICP)

Question 13

Pathological features of a SAH

Answer 13

Raised ICP, cerebral edema
Cranial nerve injury (esp 3rd)
Intracerebral or intraventricular hemorrhage
Hydrocephalus

Question 14

Hunt and Hess scale of SAH symptoms (grade 1-5)

Answer 14

1: Asymptomatic or mild headache
2. Severe headache, meningismus
3. Drowsy, confused, mild deficit
4. Stuporous, severe deficits
5. Deep coma, moribund

Question 15

3 main diagnostic procedures for an SAH

Answer 15

CT scan
Lumbar puncture (can see RBCs)
Vascular imaging

Question 16

5 secondary complications from SAH

Answer 16

Recurrent bleeding from the aneurysm
Vasospasm
Hydrocephalus
Seizures
Electrolyte abnormalities

Question 17

How does a SAH cause vasospasm

Answer 17

If you have blood on the outside of vessels, the vessels tend to constrict (irritation and chemical reaction)
Can get an ischemic stroke
Use Ca channels to reduce changes of this happening

Question 18

What size do you repair unruptured aneurysms

Answer 18

> 5 mm

Question 19

Arteriovenous malformation

Answer 19

From disordered vasculargenesis during embryology
3 components: feeding artery, nidus, draining veins
Basically a cluster of vessels with no capillary bed so high pressures go to the venous side
Can bleed

Question 20

4 clinical features of an AVM

Answer 20

Hemorrhage
Seizures
Headache
Focal neurology

Question 21

Grading of AVMs is based on what 3 factors

Answer 21

Size
Location
Deep venous drainage

Question 22

5 ways to treat AVMs

Answer 22

Nothing
Microsurgical removal
Stereotactic radiosurgery
Embolization
Combination