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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
Q

aneurysm - definition

A

an abnormal dilation of artery due to weakening of vessel wall

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26
Q

cns aneurysms - types

A
  1. Saccular (berry) aneurysm

2. Charcot-Bouchard microaneurysm

27
Q

Charcot-Bouchard microaneurysm is associated with

A

chronic hypertension

28
Q

Charcot-Bouchard microaneurysm - area

A

it affects small vessels (eg. in basal ganglia, thalamus)

29
Q

Charcot-Bouchard microaneurysm - important in diagnosis

A

not seen in angiogram

30
Q

Saccular (berry) aneurysm - area

A

bifurcations in the circle of Willis

MC site is junction of anterior communicating artery and anterior cerebral artery

31
Q

Saccular (berry) aneurysm - MC complication

A

RUPTURE –> subarachnoid hemorrhage or hemorrhagic stroke

32
Q

Saccular (berry) aneurysm - complications

A
  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
Q

Saccular (berry) aneurysm - race?

A

increased risk with blacks

34
Q

aneurysm associated with hypertension - saccular or Charcot Bouchard?

A

both

35
Q

MCC and 2nd MCC of subarachnoid hemorrhage (and proportion)

A
  1. rupture of an aneurysm (such as berry) (80%)

2. arteriovenous malformations (15%)

36
Q

subarachnoid hemorrhage - clinical signs

A

signs of meningism

37
Q

signs of berry aneyrism (not ruptured)

A
  1. bitemporal hemianopia (anterior comunicating artery)
  2. visual acuity defects
  3. CN III palsy (posterior comm)
38
Q

subarachnoid hemorrhage induced vasospam - treat with

A

nimodipine

39
Q

irreversible damage of brain begins after …. of hypoxia (time)

A

5 min

40
Q

most vulnerable areas of ischemic brain disease (which is the most)

A
  1. hipocampus (MOST) 2. neocortex 3. cerebellum

4. watershed areas

41
Q

in stroke, noncontrast CT is necessary to exclude

A

hemorrhage (before tPA can be given)

42
Q

images can detect ischemic changes in (time)

A
  1. CT–> 6-24h (but can show almost imminently hemorrhage)
  2. diffusion-weighted MRI –> 3-30 min
43
Q

12-48 h after ischemic brain disease disease - histology

A

red neurons

44
Q

24-72 h after ischemic brain disease disease - histology

A

necrosis and neutrophils

45
Q

3-5 days after ischemic brain disease disease - histology

A

macrophages (microglia)

46
Q

1-2 weeks after ischemic brain disease disease - histology

A

reactive gliosis + vascular proliferation

47
Q

> 2 weeks after ischemic brain disease disease - histology

A

glial scar

48
Q

Hemorrhagic stroke is a

A

intracerebral bleeding

49
Q

Hemorrhagic stroke is often due to

A
  1. hypertension
  2. anticoagulation
  3. cancer
  4. 2ry to ischemic stroke
50
Q

Hemorrhagic stroke as a result of cancer - mechanism

A

abnormal vessels can bleed

51
Q

Hemorrhagic stroke 2ry to ischemic stroke

A

followed by reperfusion (increased vessel fragility)

52
Q

MC side of Hemorrhagic stroke

A

basal ganglia

53
Q

ischemic stroke - pathophysiology and types

A

acute blockage of vessels –> disruption of blood flow and subsequent ischemia –> liquefactive necrosis
types: 1. thromotic 2. Embolic 3. hypoxic

54
Q

thrombotic ischemic stroke is due to / MC area

A

a clot forming directly at site of infarction usually over an atherosclerotic plague. commonly the MCA

55
Q

hypoxic ischemic stroke is due to / area

A

hypoperfusion or hypoxemia / warershed areas

56
Q

hypoxic ischemic stroke - common during

A

cardiovascular surgeries

57
Q

embolic ischemic stroke is due to / area

A
  • embolus from another part of the body obstructs vessel

- it can affect multiple vascular territories

58
Q

embolic ischemic stroke - example of causes

A
  1. atrial fibrillation

2. DVT in patent foramen ovale

59
Q

ischemic stroke - treatment

A
  1. tPA 2. Reduce risk with medical therapy
  2. optimum control of BP, blood sugar, lipids
  3. treat conditions that increase risk (eg. aspirin, clopidogrel)
60
Q

ischemic stroke - treatment - indications for tPA

A

if within if 3-4,5 h of onset

no hemmorrhage/risk of hemorrhage

61
Q

histologic features of ischemic brain disease (and times)

A 
12-48h --> red neurons 
24-72h --> necrosis and neutrophils 
3-5h --> macrophages (microglia) 
1-2weeks --> reactive gliosis + vascular proliferation
>2weeks --> glial scar
62
Q

transient ischemic attack - definition

A

Brief, reversible episode of focal neurologic dysfunction without acute infraction (-MRI), with the majority resolving in less than 15 mins

63
Q

transient ischemic attack - due to

A

temporal focal ischemia

64
Q

transient ischemic attack - permanent damage?

A

NO

neurology FA (31 decks)

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