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FA - Neurology > Neuro - Anat & Phys (Intracranial hemorrhage & Strokes) > Flashcards

Neuro - Anat & Phys (Intracranial hemorrhage & Strokes) Flashcards

Pg. 462-463 in First Aid 2014 Sections include: -Intracranial hemorrhage -Ischemic brain disease/stroke

1
Q

Name 4 kinds of intracranial hemorrhage.

A

(1) Epidural hematoma (2) Subdural hematoma (3) Subarachnoid hematoma (4) Intraparenchymal (hypertensive) hemorrhage

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2
Q

What causes an epidural hematoma? To what is it often secondary?

A

Rupture of middle meningeal artery (branch of maxillary artery), often secondary to fracture of temporal bone

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3
Q

What clinical phenomenon is characteristic of epidural hematoma patients?

A

Lucid interval

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4
Q

What are 2 kinds of damage that can result from epidural hematoma? What is the pathogenesis leading to this damage?

A

Rapid expansion under systemic arterial pressure –> (1) transtentorial herniation, (2) CN III palsy

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5
Q

Describe the CT findings characteristic of an epidural hematoma. Of these, which is the most significant characteristic?

A

CT shows biconvex (lentiform), hyperdense (light) blood collection NOT CROSSING SUTURE LINES. CAN CROSS FALX, TENTORIUM.

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6
Q

What causes a subdural hematoma?

A

Rupture of bridging veins

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7
Q

What kind of bleeding occurs with a subdural hematoma? Explain the consequence of this.

A

Slow venous bleeding (less pressure = hematoma develops over time)

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8
Q

What are 4 patient populations in which subdural hematomas are seen? What are 3 predisposing factors to subdural hematomas?

A

Seen in (1) elderly individuals, (2) alcoholics, (3) blunt trauma, (4) shaken baby (Predisposing factors: brain atrophy, shaking, whiplash)

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9
Q

Describe the CT findings characteristic of a subdural hematoma. Of these, which is the most significant characteristic?

A

Crescent-shaped hemorrhage that CROSSES SUTURE LINES. Midline shift. CANNOT CROSS FALX, TENTORIUM.

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10
Q

What are 2 causes of a subarachnoid hemorrhage?

A

(1) Rupture of an aneurysm (such as berry [saccular] aneurysm, as seen in Marfan, Ehlers-Danlos, ADPKD) or (2) an AVM (Atriovenous malformation).

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11
Q

What is an example of aneursym that could rupture and lead to subarachnoid hemorrhage? What are 3 examples of conditions associated with such an aneurysm?

A

Rupture of an aneurysm (such as berry [saccular] aneurysm, as seen in Marfan, Ehlers-Danlos, ADPKD)

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12
Q

What are 2 significant findings in the history of present illness that may suggest subarachnoid hemorrhage?

A

(1) Rapid time course (2) Patients complain of “worst headache of my life (WHOML)”

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13
Q

What is the spinal tap finding associated with subarachnoid hemorrhage?

A

Bloody or yellow (xanthochromic) spinal tap

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14
Q

What are 2 risks following subarachnoid hemorrhage? How soon after? Which of these is visible on CT?

A

2-3 days afterward, risk of (1) vasospasm due to blood breakdown (not visible on CT, treat with nimodipine) and (2) rebleed (visible on CT)

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15
Q

How is vasospasm secondary to subarachnoid hemorrhage treated?

A

Nimodipine

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16
Q

What is another name for intraparenchymal hemorrhage? What most commonly causes it?

A

Intraparenchymal (hypertensive) hemorrhage; Most commonly caused by systemic hypertension

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17
Q

Other than systemic hypertension, what are 3 other conditions in which intraparenchymal (hypertensive) hemorrhage is seen?

A

Also seen with amyloid angiopathy, vasculitis, and neoplasm

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18
Q

Where in the brain and/or in what fashion does intraparenchymal (hypertensive) hemorrhage typically occur?

A

Typically occurs in basal ganglia and internal capsule (Charcot-Bouchard aneurysm of lenticulostriate vessels), but can be lobar

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19
Q

Name an aneurysm that affects internal capsule and is associated with intraparenchymal (hypertensive) hemorrhage.

A

Charcot-Bouchard aneurysm of lenticulostriate vessels

20
Q

In the setting of ischemic brain disease or stroke, when does irreversible damage begin?

A

Irreversible damage begins after 5 minutes of hypoxia

21
Q

What 4 parts of the brain are most vulnerable to ischemic brain disease or stroke (i.e., hypoxia)?

A

Most vulnerable - (1) hippocampus, (2) neocortex, (3) cerebellum, (4) watershed areas.

22
Q

How are neurons impacted by ischemic brain disease or stroke?

A

Irreversible neuronal injury

23
Q

How is MRI used for imaging stroke? What is the most significant use of MRI in the setting of stroke?

A

Bright on diffusion-weighted MRI in 3-30 minutes (highest sensitivity for early ischemia)

24
Q

How is CT used for imaging stroke? What is the most significant use of CT in the setting of stroke?

A

Dark abnormality on noncontrast CT in ~12-24 hours. Absence of bright areas on noncontrast CT highly accurate to exclude hemorrhage (contraindication for tPA).

25
Q

Give histologic features that characterize the following periods of time since an ischemic event: (1) 12-48 hrs (2) 24-72 hrs (3) 3-5 days (4) 1-2 weeks (5) > 2 weeks.

A

(1) Red neurons (2) Necrosis & Neutrophils (3) Macrophages (4) Reactive gliosis & Vascular proliferation (5) Glial scar

26
Q

At what time period since an ischemic event can Red neurons be seen on histology?

A

12-48 hrs

27
Q

At what time period since an ischemic event can Necrosis & Neutrophils be seen on histology?

A

24-72 hrs.

28
Q

At what time period since an ischemic event can Macrophages be seen on histology?

A

3-5 days

29
Q

At what time period since an ischemic event can Reactive gliosis & Vascular proliferation be seen on histology?

A

1-2 weeks

30
Q

At what time period since an ischemic event can Glial scar be seen on histology?

A

> 2 weeks

31
Q

What is hemorrhagic stroke? To what 3 conditions is it often due?

A

Intracerebral bleeding, often due to hypertension, anticoagulation, and cancer (abnormal vessels can bleed)

32
Q

To what may hemorrhagic stroke be secondary, and why?

A

May be secondary to ischemic stroke followed by reperfusion (increased vessel fragility)

33
Q

What is the most common site of intracerebral hemorrhage?

A

Basal ganglia are most common site of intracerebral hemorrhage

34
Q

What is ischemic stroke, and what causes it? What results from ischemic stroke?

A

Acute blockage of vessels –> disruption of blood flow and subsequent ischemia; Results in liquefactive necrosis

35
Q

What are the 3 types of Ischemic stroke?

A

(1) Thrombotic (2) Embolic (3) Hypoxic

36
Q

What causes thrombotic ischemic stroke, and what is its usual context?

A

Due to a clot forming directly at the site of infarction (commonly the MCA) , usually over an atherosclerotic plaque

37
Q

What is a common site of infarction for thrombotic ischemic stroke?

A

Commonly the MCA

38
Q

What causes embolic ischemic stroke? What effect can it have?

A

An embolus from another part of the body obstructs a vessel. Can affect multiple vascular territories.

39
Q

What is often an origin/type of embolic ischemic stroke that occurs?

A

Often cardioembolic

40
Q

What causes hypoxic ischemic stroke?

A

Due to hypoperfusion or hypoxemia.

41
Q

In what context is hypoxic ischemic stroke common? What does hypoxic ischemic stroke tend to affect?

A

Common during cardiovascular surgeries, tends to affect watershed areas

42
Q

What is the treatment for ischemic stroke? What are the requirements for use of this treatment?

A

Treatment - tPA (if within 3-4.5 hr of onset and no hemorrhage/risk of hemorrhage)

43
Q

What are 3 broad categories for reducing risk of ischemic stroke?

A

Reduce risk with (1) medical therapy (e.g., aspirin, clopidogrel); (2) Optimum control of blood pressure, blood sugars, and lipids; and (3) treat conditions that increase risk (e.g., atrial fibrillation)

44
Q

What criteria/characteristics define Transient ischemic attack? What causes the deficits in this case?

A

Brief, reversible episode of focal neurologic dysfunction without acute infarction (negative MRI), with majority resolving in < 15 minutes (Note: TIA diagnosis is now tissue based); Deficits due to focal ischemia

45
Q

What are 2 examples of medical therapy that may reduce risk of ischemic stroke?

A

(1) Aspirin (2) Clopidogrel

46
Q

What is an example of an underlying condition that may be treated in order to reduce risk of ischemic stroke?

A

Atrial fibrillation

47
Q

What are 3 clinical values to get under optimum control in order to reduce risk of ischemic stroke?

A

(1) Blood pressure (2) Blood sugars (3) Lipids

FA - Neurology (30 decks)

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