L17 Haemorrhagic Stroke

Question 1

Where is the Falx Cerebri located

Answer 1

dura mater between longitudinal fissure

separates hemispheres

Question 2

Where is the Tentorium Cerebelli located

Answer 2

tent-like partition between cerebrum and cerebellum

Question 3

Name of the 2 layers of dura mater

Answer 3

periosteal layer

meningeal layer

Question 4

Where do fingerlike projections of arachnoid mater penetrate

Answer 4

meningeal layer of dura

Question 5

Two types of haemorrhagic stroke

Answer 5

ICH and SAH

Question 6

Where does a ICH occur and what is the most common cause

Answer 6

brain parenchyma

long-standing hypertension

Question 7

Deposits of what can cause ICH

Answer 7

amyloid
cerebral amyloid angiopathy (CAA)
amyloid deposition on walls of arterioles = weakening of vessel wall

Question 8

less common cause of ICH

Answer 8

vascular malfunction (abnormal connections between arterial and venous vessels)
charcot-bouchard aneurysm

Question 9

What is ICH the rupture of

Answer 9

arterioles in deep non-cortical structures

Question 10

Pathogenesis of Charcot-Bouchard aneurysm

Answer 10

chronic hypertension –> deposition of lipid-hyaline substances on walls of small arterioles –> weaken vessel wall
occur deep in brain (penetrating vessels)

Question 11

Clinical features of ICH

Answer 11

associated with area of brain affected
rapid LOC
headache
vomiting
seizures

Question 12

Outcomes of ICH

Answer 12

death within 24-48 hours

survivors often left with deficits

Question 13

Most common cause of SAH

Answer 13

bleeding from berry aneurysm

Question 14

What is a berry aneurysm and what can they be caused by

Answer 14

occur at branch points of circle of willis
developmental defects in elastic lamina or acquired defects in artery

infection, inflammation, atherosclerosis, hypertension (exacerbates deficit)

Question 15

What can rupture of berry aneurysm cause

Answer 15

SAH or ICH

Question 16

SAH clinical features

Answer 16

sudden onset of WORST HEADACHE IN  LIFE
stiff neck
nausea
seizures
LOC

Question 17

Complications of ICH and SAH

Answer 17

acute or chronic hydrocephalus
cerebral oedema
vasospasm

Question 18

What is peri-haematomal oedema (PHE)

Answer 18

swelling around haematoma
common following ICH
treatment: reduce cerebral oedema volume

Question 19

What is vasospasm and how is it treated

Answer 19

collapsed vessels

treatment: Ca2+ channel blocker (nimodipine) to prevent ischaemic injury but can cause hypotension

Question 20

When can tPA be used for ICH treatment

Answer 20

when haematoma has stabilized
dissolves clot
inserted via catheter