Intracerebral Hemorrhage in Older Adults Flashcards
Which of the following are the risk factors of spontaneous intracerebral hemorrhage in adults?
● A. Age: the incidence increases after 55 years of age and doubles with each decade of age until the age of more than 80 years when incidence is 25 times that during previous decade
● B. Gender: more common men
● C. Previous stroke
● D. Alcohol consumption
● E. Cigarette smoking and street drugs
● F. Liver dysfunction
● G. All of the above
G. All of the above
Common arterial feeders of ICH include lenticulostriates, thalamoperforators, and paramedian branches of basilar artery. What is the most common site of spontaneous ICH which constitutes about 50%?
● A. Striate boyd (basal ganglia) in which putamen is the most common
● B. Thalamus
● C. Pons
● D. Cerebellum
● E. Cerebral white matter
A. Striate boyd (basal ganglia) in which putamen is the most common
Lobar hemorrhages are more common in people with high alcohol consumption, and it can involve frontal, parietal, occipital, or temporal lobe. Following are the etiologies of lobar hemorrhage except?
● A. Extension of deep hemorrhage
● B. Amyloid angiopathy
● C. Hemorrhagic tumor
● D. Hemorrhagic transformation of ischemia can never cause it
● E. AVM
● F. Aneurysm
D. Hemorrhagic transformation of ischemia can never cause it
What is the factor that constitutes up to two-thirds of the cerebellar hemorrhages?
● A. Hypertension
● B. AVM
● C. Aneurysm
● D. Smoking
● E. Diabetes mellitus
D. Smoking
Cerebral amyloid angiopathy (CAA) is pathologic deposition of beta amyloid protein within the media of small meningeal and cortical vessels without evidence of systemic amyloidosis. Definite diagnosis of CAA can be made only on full postmortem. Which of the following is probably CAA with supporting
pathological evidence for CAA?
● A. Lobar, cortical, or corticosubcortical hemorrhage
● B. Some degree of vascular amyloid deposition in biopsy specimen
● C. Absence of another diagnostic lesion
● D. All of the above
D. All of the above
Malignant tumors most commonly involving ICH include the following except?
● A. Glioblastoma
● B. Lymphoma
● C. Medulloblastomas and gliomas
● D. Renal cell carcinoma and bronchogenic carcinoma
● E. Metastatic tumors like melanoma or choriocarcinoma
C. Medulloblastomas and gliomas
Delayed deterioration after the initial hemorrhage is usually due to any combination of the following?
● A. Rebleeding
● B. Edema
● C. Hydrocephalus
● D. Seizures
● E. Increased ICP
● F. All of the above
F. All of the above
Following statements are correct regarding variation of brain MRI signal characteristics of intraparenchymal blood over time except?
● A. Hyperacute blood is within first 6 hours; it consists of oxyHgb and appears isointense on T1 and hyperintense on T2 MRI
● B. Acute is from 6 to 72 hours, which consists of deoxy-Hgb which appears isointense on T1 and hypointense on T2
● C. Early subacute which is from 3 to 7 days; it consists of met-Hgb (intracellular) which is hyperintense on T1 and hypointense on T2 MRI
● D. Late subacute is from 7 to 14 days which consist of met-Hgb (extracellular) which is hyperintense on both T1 and T2 images
● E. Chronic which is more than 14 days and consists of hemosiderin. It appears hyperintense on both T1 and T2 MRI images
E. Chronic which is more than 14 days and consists of hemosiderin. It appears hyperintense on both T1 and T2 MRI images
ICH scores of 0, 1, 2, 3, 4, 5, and 6 correlate with 30-day mortality of 0, 13, 26, 72, 97, 100, and 100%, respectively. Which of the following are the components of ICH score?
● A. GCS (with score 2 for GCS 3–4, score 1 for GCS 5–12, score 0 for GCS 13–15)
● B. Age (with age above 80 years comprising score 1 while below 80 years it is 0)
● C. Location (1 for infratentorial and 0 for supratentorial)
● D. ICH volume (1 for > 30 mL while 0 for < 30 mL)
● E. Intraventricular blood (1 for presence and 0 for absence)
● F. All of the above
F. All of the above
Indications for ventriculostomy after ICH include which of the following?
● A. Acute hydrocephalus and management of ICP
● B. For evacuation of ICH in brain parenchyma
● C. For low GCS patients
● D. In patients who are not surgical candidates with large ICH
● E. In patients who cannot tolerate surgery
A. Acute hydrocephalus and management of ICP
What is the most common site for spontaneous ICH?
● A. Basal ganglia
● B. Thalamus
● C. Pons
● D. Cerebellum
● E. Brainstem
A. Basal ganglia
What is the source of putaminal hemorrhage in spontaneous ICH?
● A. Lenticulostriate
● B. Thalamoperforators
● C. Basilar artery
● D. Vertebral artery
● E. Extension from cortical ICH
A. Lenticulostriate
Hemorrhagic transformation of an ischemic stroke where the hemorrhage is extending beyond the margins of the ischemia is categorized as which type?
● A. Type I
● B. Type II
● C. Type III
● D. Type IV
● E. Complex
B. Type II
The diagnosis of cerebral amyloid angiopathy is best confirmed with which of the following?
● A. Postmortem histopathology
● B. Catheter angiogram
● C. CTA
● D. MRA
● E. MRV
A. Postmortem histopathology
Which of the following metastatic tumors is not associated with ICH?
● A. Melanoma
● B. Bronchogenic carcinoma
● C. Renal cell carcinoma
● D. Choricarcinoma
● E. Prostate carcinoma
E. Prostate carcinoma
