Neurosurgery - Brain Haemorrhage Flashcards
at which point do saccular aneurysms usually occur
a.straight vessels
b.unbranched vessels
c.branched vessels
d.branching points
d.branching points
localised dilations of blood vessel walls
saccular aneurysms
what is the fundus of a saccular aneurysm composed of
a.adventitia and media
b.adventitia and intima
c. media and intima
b.adventitia and intima
thunderclap headache, vomiting, neck stiffness , photophobia and seizure /loss of consciousness indicates what
a.meningitis
b.migraine
c.unruptured brain aneurysm
d.ruptured brain aneurysm
d.ruptured brain aneurysm
examinations for ruptured brain aneurysm
Glasgow coma scale
Pupils
fundoscopy
peripheral nervous system
which of these is not a risk factor for brain aneurysm
a,smoking
b.hypertension
c.alcohol excess
d.strong family history
e.obesity
e.obesity
what initially is done to diagnose a ruptured brain aneurysm
a. CT brain
b.x RAY
c.MRI
d.ECG
e.EEG
a. CT brain
if the CT is negative following suspected ruptured brain aneurysm what is done
a.EEG
b.ECG
c.Bloods
D.lumbar puncture
D.lumbar puncture
a lumbar puncture should be done how long after a stroke due to suspected ruptured brain aneurysm
a.<1 hr
b.>5 hrs
c.>8 hrs
d.>12 hrs
d.>12 hrs
RBC lysis, HB released and metabolised to oxyHb and bilirubin
– Bilirubin is only formed in vivo and appears after 10hours
where is the ilaic crest
a.L1
b.L2
c.L3
d.L4
d.L4
where is a lumbar puncture usually done between
a. L1 -L2
b.L2-L3
c.L3-L4
c.L3-L4
which of these structures does a lumbar puncture needle NOT penetrate
a.supraspinous ligament
b. interspinous ligaments
c.ligamentum flavum
d.posterior longitudinal
d.posterior longitudinal
which of these structures does a lumbar puncture needle NOT penetrate
a.supraspinous ligament
b. interspinous ligaments
c.ligamentum flavum
d.anterior longitudinal
d.anterior longitudinal
a lumbar puncture sample should be sent to the lab
a.urgently
b.with other samples
c.after 12 hours
d.after light exposure
a.urgently
PROTECT FROM LIGHT
avoid lysis of RB forming oxy Hb
which of these contraindicates a patient against LP
a.recent stroke
b.hypertension
c.obesity
d.caogulopathy
d.caogulopathy
true or false lumbar puncture should be done on a patient with focal neurology and abnormal concious level in whom brain imaging is unknown
a. true
b.false
b.false
contraindicated
eg posterior fossa mass or lateral mass effect on brain imaging casuing displacement of midbrain/ cerebral hemispheres
which of these contraindicates a patient against LP
a.recent stroke
b.hypertension
c.obesity
d.local infection at puncture site
d.local infection at puncture site
if a SAH is confirmed what should be done next
a.CT brain
b.LP
c.CTA
d.CA
c.CTA
CT angiography
then CA - Catheter angiogram if necessary (x rays of heart)
catheter insertion into artery in leg/groin tube guided into head and into aneurysm and platinum coils used to fill aneurysm so blood can no longer enter it
a.coiling
b.clipping
a.coiling
what drug is given to reduce the chances of secondary cerebral ischameia after an SAH
a.amlodipine
b.nimodipine
c.phenytoin
d.promethazine
b.nimodipine
death , stroke, bleeding and seizure are side effects of which SAH treatment
a.coiling
b.clipping
b.clipping
a cut in the scalp and small removal of bone (craniotomy) to allow for a small metal clip to be fitted around the base of the aneurysm to seal it shut describes which SAH treatment
a.coiling
b.clipping
b.clipping
subarachnoid haemorrhage is graded on what scale
a.GCS
b.GRACE
c.GOLD
d.WFNS
d.WFNS
world federation of neurological symptoms
combines glasgow coma scale and neurological symptoms
what is given to prevent hypervolaemia and decrease risk of vasospasm post SAH
a.50ml/hr normal saline
b.125 ml/hr normal saline
c.200ml/hr normal saline
b.125 ml/hr normal saline
initial rescue measures for vasospasm folllowing SAH
a.nimodipine
b.125ml/hr saline
c.hypertensive therapy
d.chemical angiolasty with nimodipine
e.bolus iv saline/colloid
e.bolus iv saline/colloid
c.hypertensive therapy
d.chemical angiolasty with nimodipine
main complication of subarachnoid haemorrhages
a.cerebral ischaemia
b.hydrocephalus
c.seizures
d.low sodium
e.ECG changes
d.pulmonary oedema and pneumonia
a.cerebral ischaemia
ECG changes mimic MI as troponin rises
when is screening for intracranial aneurysm offered
a.one first degree relative
b.2+ first degree relatives
c.2+ first degree relatives and 1+ second degree relatives
b.2+ first degree relatives
8% risk of aneurysm
what is used to predict risk of rupture of Intracranial aneurysm
a.WFNS
b.QRISK
c,GCS
d.PHASES
e.GRACE
d.PHASES
which of these is not a predictor of aneurysm rupture
a.age
b.hypertension
c.aneurysm size
d.smoking
e.location
d.smoking
tangled fistulous connections between arteries and veins , centred on a nest (nidus) , vascular mass replaces the capillary bed where shunting occurs
aterio venous malformation
what is the main treatment for AVM
a.lifestyle changes
b.drugs
c.surgery
c.surgery
treatment for AVM radiation induced endothelial damage with smooth muscle proliferation occluding vessel lumen
stereotactic radiosurgery
which of these is not a complication of stereotactic radiosurgery
a.cerebral infarction
b.radiation necrosis
c.bleeding
d.seizures
a.cerebral infarction
main cause of intracranial haemorrhages
a.hypertension
b.vascular lesions
c.coagulation disorders
e.vasculitis
a.hypertension
dural AV fistula between the cavernous part of the internal carotid artery and the cavernous sinus or its venous outflow
a.SAH
b.Arterio venous malformation
c.carotid cavernous fistula
c.carotid cavernous fistula
orbital bruit, exopthalmos (bulging eyeballs) and pulsatile tinnitus what does this indicate
a.SAH
b.Arterio venous malformation
c.carotid cavernous fistula
c.carotid cavernous fistula
how is carotid cavernous fistula treated
a. nimodipine
b.125ml/hr saline
c.surgery
d.coiling
e.endovascular treatment
e.endovascular treatment
possible causes of thunderclap headache
SAH
migraine
ice pick
trigeminal neuralgia
cluster
tension
ischaemic stroke , venous sinus thrombosis
pituitary apoplexy
carotid dissection
meningitis
brain tumour
what is the main reason to treat a ruptured aneurysm early
a.prevent rebleed
b.prevent hydrocephalus
c.prevent vasospasm
d.prevent seizure
a.prevent rebleed
which of the following is not a risk factor for SAH
a.aaaa
b.smoking
c.hypertension
d.polycystic kidney disease
a.aaaa
