Neurotrauma And Cerbrovascular Events Flashcards
How is cerebral perfusion pressure calculate and what is it optimally
CPP= MAP- ICP
Should be between 50-60
How does a haemorrhage lead to dilated pupils
Raised ICP causes uncal herniation - leads to ipsilateral pupil dilation
Mainstays of treatment with possible herniation
Intubation and anaesthesia
Osmotic therapy to reduce ICP
CT scan
CT scan appearance of each brain bleed
Extra dural = convex shape (lemon)
Sub dural= Concave /crescent shaped
Subarachnoid haemorrhage = hyper attenuation around circle of Willis
Most common aetiology of extra dural bleed
Pterion fracture causes tear in middle meningeal artery
In what kind of brain bleed is a lucid period seen
Extra dural
Which type of brain bleed is caused by rupture of bridging veins
Sub dural
What kind of brain bleeds are the elderly and alcoholics most likely to suffer
Sub dural
What score can be used to assess likelihood of a stroke
ROSIER
Ix for SAH: thunderclap headache
Non contrast CT, then LP 12 hours later
Aeitiology of SAH
Ruptured berry aneurysm
Complications of a SAH and how they are managed
Catecholamine storm - accepted most often to maintain CPP at 80-90 post SAH
Hydrocephalus (day 0 or 1)- can be communicating or not. Shunts and LP used
HYPONATREIMIA often due to SIADH (day2) - Managed via fluid restriction and sodium replacment
Cerebral vasospasm (day 3)- good perfusion with at least 3L per day, and nimodipine
What are the three things evaluated in the oxford stroke classification
Unilateral hemiparesis and/or hemisensory loss of the arm face or leg
Homonomynous hemianopia
Higher cognitive dysfunction
What arteries are involved in a total anterior circulation infarct
Anterior and middle cerebral artery
What arteries are involved in a PACS
Smaller arteries of anterior circulation
What arteries are involved in a lacunar infarct
Perforating arteries around internal capsule, thalamus and basal ganglia
What arteries are involved in a posterior circulation infarct
Difference between anterior and middle cerbral artery stroke
Anterior infarct affects lower extremities more
What is seen in a TACI
Contralateral hemiparesis or sensory loss
Higher cognitive dysfunction (speech, comprehension)
Homynomus hemianopia
What is seen in PACI
Two of:
Contralaeteral weakness or hemisensory loss
Visual field defect
Higher cortical dysfunction
Classic finding in anterior cerebral artery stroke
Contralateral weakness or sensory loss in the lower limbs
In which kind of stroke will you see only higher cortical dysfunction
PACS
Posterior circulation stroke involves which artery and what are the clinical features
Involves vertebrobasilar artery
Causes 1 of:
Cerebellar or brain stem syndromes
LOc
Isolated homonymous hemianopia
What is a lacunar stroke and what does it cause
Involves perforating arteries around thalamus, basal ganglia and internal capsule
Causes 1 of the following:
Unilateral weakness or sensory loss
Pure sensory stroke
Ataxic hemipareisis
