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Neuro II > Intracranial Hemorrhage Disorder > Flashcards

Intracranial Hemorrhage Disorder Flashcards

1
Q

What are the 2 most common types of intracranial hemorrhage seen in stroke & what demographics are most commonly affected by each?

A
  • Subarachnoid hemorrhage (5-10% all strokes)
    • mean age ~50 yr
    • 55% men - but men predominate until 50
  • Intracranial hemorrhage (10-15% all strokes)
    • after 55 yr
    • men > women
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2
Q

Identify the type of hemorrhage indicated by the black blocks show on the provided image:

A
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3
Q

What is the most common cause of a epidural hemorrhage?

A

traumatic, s/p skull fracture involving middle meningeal artery

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4
Q

What is the most common cause of subdural hemorrhage?

A

usually post traumatic s/p fall in elderly patient causing rupture of bridging veins

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5
Q

What is the most common cause of intraparenchymal hemorrhage?

A

hypertension, tumor

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6
Q

What is the most common cause of subarachnoid hemorrhage

A

trauma, aneurysm rupture

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7
Q

What areas are predisposed to having intraparenchymal hemorrhage?

A

basal ganglia

frontal & posterior(?) lobes

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8
Q

What type of hemorrhage is depicted in the provided image?

What is the classic presentation of this type of hemorrhage?

A

Epidural hematoma

Presentation: head trauma w/ brief loss of consciousness → lucid interval → obtunded state → headache

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9
Q

What is the most common location for an epidural hematoma & what findings would you expect to see on an exam?

Treatment?

A

temporal lobes

contralateral hemiparesis & ipsilateeral pupil dilation

treatment: operating room

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10
Q

What type of hemorrhage is depicted in the provided image?

What is the classic presentation of this type of hemorrhage?

A

Subdural Hematoma

head trauma, headache, alerted awareness

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11
Q

What demographics are most commonly affected by subdural hematoma & what findings would you expect to see on an exam?

Treatment?

A

elderly with atrophy / alcoholism

treatment: situational

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12
Q

What does the FUNC score estimate?

A

the likelihood of functional independence 90 days after diagnosis of intracranial hemorrhage

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13
Q

FUNC score is dependent on what variables?

A

blood volume

age

location of hemorrhage

Glasgow coma scale

pre-ICH cognitive impairment

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14
Q

Surgeons hold that operation is warranted for intracerebral hemorrhage if the blood volume is what number?

A

30 or more

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15
Q

0% of patients with a FUNC score of what number gained functional independence after 90 days?

A

4 or less

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16
Q

80% of patients with a FUNC score of what number gained functional independence after 90 days?

A

11

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17
Q

What type of hemorrhage is depicted in the provided image?

A

Subarachnoid (sulci have a lot of hyperdensities)

also has interventricular extension

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18
Q

What type of hemorrhage is depicted in the provided image?

A

Stroke with hemorrhagic transformation

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19
Q

What factors predispose someone to having a hemorrhagic stroke?

A
  • Hypertensive vascuopathy (5x)
  • cerebral amyloid angiopathy
  • aneurysm / AV malformation
    • esp subarachnoid
  • excessive EtOH intake
  • Smoking (1.5-2x)
  • Illicit drugs
    • cocaine / amphetamines
  • Women with migraine aura
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20
Q

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

A

cerebral amyloid angiopathy

21
Q

What type of hemorrhage is depicted in the provided image?

What is the classic presentation of this type of hemorrhage?

A

Intraparenchymal Hemorrhage

progressive headache, lethargy, vomiting & stroke symptoms

22
Q

How do vascular territories help differentiate between ischemic stroke & intraparenchymal hemorrhage?

A

ischemic: respect of vascular territory

intraparenchymal hemorrhage: no respect of vascular territories

23
Q

What are the symptoms of a primary brain hemorrhage in the following area:

basal ganglia

A

contralateral hemiparesis

sensory loss

contralateral conjugate gase paresis

24
Q

What are the symptoms of a primary brain hemorrhage in the following area:

lobar regions

A

contralateral hemiparesis or sensory loss

aphasia

neglect

confusion

25
Q

What are the symptoms of a primary brain hemorrhage in the following area:

Thalamus

A

contralateral hemiparesis

sensory loss

abnormal eye movement

26
Q

What are the symptoms of a primary brain hemorrhage in the following area:

pons

A

quadriparesis

facial weakness

decreased level consciousness

miosis

27
Q

What are the symptoms of a primary brain hemorrhage in the following area:

cerebellum

A

ataxia

gaze paresis

herniation

coma

28
Q

Subarachnoid hemorrhages are often caused by what?

A

aneurysm rupture

29
Q

Where do aneurysms commonly occur? Where do aneurysms commonly rupture?

A

anterior communicating artery (pupillary abnormalities & extraocular movements)

Posterior circulating aneurysms have high risk of rupture

30
Q

What is shown in the provided image?

A

saccular (berry) Aneurysm

31
Q

What is the presentation of a patient with a subarachnoid hemorrhage?

A

“worst headache ever”

with nausea, vomiting, photophobia, neck stiffness, decreased level consciousness, ocular vitreous hemorrhage; (seizure is atypical)

32
Q

What are both the modifiable & non-modifiable risk factors for subarachnoid hemorrhage?

A
  • non-modifiable
    • age, female, prior history of aneurysmal SAH, family history aneurysm in 1st degree relative, cerebral aneurysm >7mm
  • modifiable
    • hypertension, cigarette smoking, heavy alcohol use, sympathomimetic drug use (cocaine)
33
Q

What are the two type of grading scales for subarachnoid hemorrhage?

A
  • Hunt Hess grade (survival)
    • take into account clinical status, responsiveness, & degree neurologic deficit
  • Radiographic (spasm risk)
    • based on radiographic imaging
    • important for plan or care
34
Q

If a SAH is suspected, but the CT is negative, what should you do?

A
  • lumbar tap to look for xanthochromia (collected in 4 separate tubes)
    • seen 12 hr after SAH develops
    • absent after 14 days
  • CT angiogram to exclude aneurysm
  • MRI to evaluate possible vascular malformation
35
Q

CT is 98-100% sensitive for SAH when performed within what timeframe?

A

12 hrs

36
Q

Eye pointing “down & out” is indicative of what nerve palsy?

In what situations is the pupil dilated & in what situations is is spared?

A

CN III

  • dilated
    • PCOM aneurysm vs. tumor
  • spared
    • intrinsic nerve ischemia (ie. diabetes)
37
Q

What are the goals of treatments for SAH?

A
  • Prevent-re-bleeding
  • prevent vasospasm
  • endovascular coiling
  • maintain euvolemia
  • maintain normla intracranial pressure
38
Q

How do we prevent rebedding in patients with SAH? When is the highest risk of this happening?

A

systolic blood pressure <160mmHg

first 6 hrs

39
Q

How do we prevent vasospasm in patient with SAH? Why do we want to prevent this?

A

nimodipine in all patients

decreases risk of delayed cerebral ischemia (4-14 days after SAH)

40
Q

Why might a person have a poor outcome in the situation of SAH?

A
  • if don’t optimize fluid, BP, sodium
  • non-optimal body temperature
  • anemic
  • hypoglycemia
41
Q

What are the principles of critical care management?

A
  • blood oxygen content & delivery
  • fuel (glucose) content & delivery
  • oxygen consumption
42
Q

The complication of a hyoptonic hyopnatremic state can occur in what situations?

A
  • SAH (⅓ all patients)
  • ICH
  • Massive stroke
  • severe TBI
  • meningitis/encephalitis
43
Q

What are the complications we see in patients with SAH?

A
  • cerebral edema
  • seizures
  • herniation
  • neurogenic shock
  • hypertension
  • rebleed
    • reversal anticoagulation agents
    • no tPA
    • exception: DVT prophylaxis
44
Q

Why might you get a MRI if you see hyperdensity on CT of the head?

A

to see the arteriovenous malformations that are present in 0.1-0.2% of population

45
Q

What is arteriovenous malformation & why can it be a problem?

A

fistulous connections of arteries & veins without normal intervening capillary beds

40% intracerebral hemorrhage in patients 15-45 due to AVM

presentation is hemorhhage/seizures

46
Q

What are cavernous malformations & why can they cause a problem?

A

vascular malformations composed of endothelial-lined caverns; endothelia has defective tight junctions which can leak

may co-exist with developmental venous anomaly

present with brain hemorrhage / seizures

47
Q

Patients with cavernous malformations are more at risk of rupture with what additional predisposing conditions?

How does a cavernous malformation appear on imaging?

A

if located in brainstem in a female with multiple other CM

popcorn/mulberry appearance

48
Q

What is the main cause of developmental venous anomolies?

A

via intrauterine event resulting in focal arrest of venous development

rarely symptomatic

49
Q

What can reduce morbidity & mortality in subarachnoid hemorrhage & intracerebral hemorrhage?

A

early surgery & critical care management

Neuro II (30 decks)

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