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neurology FA > intracranial hemorrhage > Flashcards

intracranial hemorrhage Flashcards

1
Q

intracranial hemorrhage - types

A
  1. epidural hematoma
  2. subdural hematoma
  3. subarachnoid hemorrhage
  4. intraparenchymal (hypertensive) hemorrhage
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2
Q

epidural hemorrhage - mechanism

A

rupture of middle meningeal artery –> rapid expansion (artery)

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3
Q

causes of middle meningeal artery rupture

A

often 2ry to fracture of temporal bone

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4
Q

middle meningeal artery is a branch of

A

maxillary artery

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5
Q

epidural hemorrhage - course

A
  • Lucid interval (a temporary improvement in a patient’s condition after a traumatic brain injury)
  • rapid expansion under systemic arterial pressure
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6
Q

epidural hemorrhage - complications

A
  1. transtentorial herniation

2. CN III

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7
Q

epidural hematoma - CT

A
  • biconvex (lentiform), hyperdense blood collection
  • not crossing suture lines
  • can cross falx, tentorium
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8
Q

cerebri falx in greek

A

δρέπανο εγκεφάλου

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9
Q

subdural hematoma - mechanism

A

rupture of bridging veins –> slow venous bleeding

(less pressure because of veins= hematoma develops over time). Can be acute or chronic

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10
Q

subdural hematoma is seen in

A
  1. elderly 2. alcoholics 3. blunt trauma 4. shaken baby
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11
Q

subdural hematoma - predisposing factors

A
  • brain atrophy
  • shaking
  • whiplash
  • anti-coagulation
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12
Q

subdural hematoma - CT

A
  • Crescent-shaped hemorrhage
  • crosses sature lines
  • Midline shift
  • Cannot cross falx, tentorium
  • findings of “acute on chronic” haemorrhage
  • if acute –> hyperdense, if chronic –> hypodense
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13
Q

causes of subarachnoid hemorrhage

A
  1. rupture of an aneurysm (such as berry)

2. arteriovenous malformations

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14
Q

Saccular (berry) aneurysm - associations and risk factors

A
  1. ADPKD
  2. Ehlers-Danlos syndrome
  3. advanced age
  4. hypertension
  5. smoking
  6. race (increased risk with black)
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15
Q

subarachnoid hemorrhage - course

A

rapid course

“worst headache of my life”

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16
Q

subarachnoid hemorrhage - spinal tap

A

blooddy or yellow (xanthochromic)

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17
Q

subarachnoid hemorrhage - complications after 4-10 days

visible on CT

A
  1. vasospasm due to blood breakdown –> ischemic infract (not visible in CT)
  2. rebleed (visible in CT)
  3. high risk of developing communicating and/or obstructive hydrocephalus
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18
Q

subarachnoid hemorrhage - CT

A

subarachnoid blood in sulci and intraventricular blood layering in posterior horn of lateral ventricles

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19
Q

intraparenchymal (hypertensive) hemorrhage - is caused by

A
  1. hypertension (MCC)
  2. amyloid angiopathy
  3. vasculitis
  4. neoplasm
    (can cause Charcot-Bouchard)
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20
Q

intraparenchymal (hypertensive) hemorrhage - area

A

typically occurs in basal ganglia and internal capsule (Charcot-Bouchard aneurysm of leniculostriate vessels)
can be lobar

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21
Q

cause of reccurent lobar hemorrhage stroke in elderly

A

amyloid angiopathy

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22
Q

intraparenchymal (hypertensive) hemorrhage - amyloid angiopathy –> (a typical presentation)

A

recurrent lobar hemorrhagic stroke in elderly

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23
Q

Whiplash is a

A

neck injury due to forceful, rapid back-and-forth movement of the neck, like the cracking of a whip

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24
Q

MCC of intraparenchymal (hypertensive) hemorrhage

A

hypertension

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25
aneurysm - definition
an abnormal dilation of artery due to weakening of vessel wall
26
cns aneurysms - types
1. Saccular (berry) aneurysm | 2. Charcot-Bouchard microaneurysm
27
Charcot-Bouchard microaneurysm is associated with
chronic hypertension
28
Charcot-Bouchard microaneurysm - area
it affects small vessels (eg. in basal ganglia, thalamus)
29
Charcot-Bouchard microaneurysm - important in diagnosis
not seen in angiogram
30
Saccular (berry) aneurysm - area
bifurcations in the circle of Willis | MC site is junction of anterior communicating artery and anterior cerebral artery
31
Saccular (berry) aneurysm - MC complication
RUPTURE --> subarachnoid hemorrhage or hemorrhagic stroke
32
Saccular (berry) aneurysm - complications
1. rupture (--> subarachnoid hemorrhage or hemorrhagic stroke) 2. bitetemporal hemianopia (via compression of optic chiasm) (anterior comm) 3. visual acuity deficits (anterior comm) 4. CN III palsy (posterior comm)
33
Saccular (berry) aneurysm - race?
increased risk with blacks
34
aneurysm associated with hypertension - saccular or Charcot Bouchard?
both
35
MCC and 2nd MCC of subarachnoid hemorrhage (and proportion)
1. rupture of an aneurysm (such as berry) (80%) | 2. arteriovenous malformations (15%)
36
subarachnoid hemorrhage - clinical signs
signs of meningism
37
signs of berry aneyrism (not ruptured)
1. bitemporal hemianopia (anterior comunicating artery) 2. visual acuity defects 3. CN III palsy (posterior comm)
38
subarachnoid hemorrhage induced vasospam - treat with
nimodipine
39
irreversible damage of brain begins after .... of hypoxia (time)
5 min
40
most vulnerable areas of ischemic brain disease (which is the most)
1. hipocampus (MOST) 2. neocortex 3. cerebellum | 4. watershed areas
41
in stroke, noncontrast CT is necessary to exclude
hemorrhage (before tPA can be given)
42
images can detect ischemic changes in (time)
1. CT--> 6-24h (but can show almost imminently hemorrhage) 2. diffusion-weighted MRI --> 3-30 min
43
12-48 h after ischemic brain disease disease - histology
red neurons
44
24-72 h after ischemic brain disease disease - histology
necrosis and neutrophils
45
3-5 days after ischemic brain disease disease - histology
macrophages (microglia)
46
1-2 weeks after ischemic brain disease disease - histology
reactive gliosis + vascular proliferation
47
>2 weeks after ischemic brain disease disease - histology
glial scar
48
Hemorrhagic stroke is a
intracerebral bleeding
49
Hemorrhagic stroke is often due to
1. hypertension 2. anticoagulation 3. cancer 4. 2ry to ischemic stroke
50
Hemorrhagic stroke as a result of cancer - mechanism
abnormal vessels can bleed
51
Hemorrhagic stroke 2ry to ischemic stroke
followed by reperfusion (increased vessel fragility)
52
MC side of Hemorrhagic stroke
basal ganglia
53
ischemic stroke - pathophysiology and types
acute blockage of vessels --> disruption of blood flow and subsequent ischemia --> liquefactive necrosis types: 1. thromotic 2. Embolic 3. hypoxic
54
thrombotic ischemic stroke is due to / MC area
a clot forming directly at site of infarction usually over an atherosclerotic plague. commonly the MCA
55
hypoxic ischemic stroke is due to / area
hypoperfusion or hypoxemia / warershed areas
56
hypoxic ischemic stroke - common during
cardiovascular surgeries
57
embolic ischemic stroke is due to / area
- embolus from another part of the body obstructs vessel | - it can affect multiple vascular territories
58
embolic ischemic stroke - example of causes
1. atrial fibrillation | 2. DVT in patent foramen ovale
59
ischemic stroke - treatment
1. tPA 2. Reduce risk with medical therapy 3. optimum control of BP, blood sugar, lipids 4. treat conditions that increase risk (eg. aspirin, clopidogrel)
60
ischemic stroke - treatment - indications for tPA
if within if 3-4,5 h of onset | no hemmorrhage/risk of hemorrhage
61
histologic features of ischemic brain disease (and times)
``` 12-48h --> red neurons 24-72h --> necrosis and neutrophils 3-5h --> macrophages (microglia) 1-2weeks --> reactive gliosis + vascular proliferation >2weeks --> glial scar ```
62
transient ischemic attack - definition
Brief, reversible episode of focal neurologic dysfunction without acute infraction (-MRI), with the majority resolving in less than 15 mins
63
transient ischemic attack - due to
temporal focal ischemia
64
transient ischemic attack - permanent damage?
NO

neurology FA (31 decks)

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