Non-traumatic Neuro Emergencies Flashcards
locatians of saccular aneurysms
ACoA
MCA - sylvian fissure
Basilarytip, SCA, PICA, VA
Typically at areas of bifurcation - 90% anterior circulation
DDx for aneurysmal SAH
Non-aneurysmal SAH - traumatic, perimesencephalic, NOS (AVM, AVF, cavernous hemangioma)
Reversible cerebral vascoconstriction syndrome
Pseudo-SAH
Risk factors for Berry Aneurysms
Family history
Adult polycystic kidney disease
aortic coarctation
Risk of aneurysm rupture
Female, smoker, HTN
Risk factors for fusiform aneurysms
Dissection from trauma Hyperension ASVD Fibromuscular dysplasia Marfan's Ehlers-Danlos Infection - mycotic
What is the timeline of vasospasm?
Starts Day 3-4
Peaks Day 7-9
Lasts 12-16 days
What is the Fischer CT grading for SAH?
1 - No SAH visible
2 - Diffuse, thin layer 1mm
4 - intraventricular blood
What is the treatment for vasospasm?
Triple H therapy:
Hypervolemia, hemodilution, hypertension
What is the cause and course of a perimesencephalic SAH
Benign course -
What are typical locations and aetiology for primary spontaneous intracranial hemorrhage?
Hypertensive - deep gray matter (basal ganglia, thalamus), pons, cerebellar hemisphere
Amyloid - lobar
AVM - any locations
Cavernous malformation - any location common in brain stem
Venous sinus thrombosis - subcortical white matter adjacent to occluded sinus
Neoplasm - any location
Differential for parenchymal hypo density?
Infarction Infiltrating neoplasm Cerebral contusion inflammation - cerebritis, encephalitis Evolving encephalomalacia Dural venous thrombosis - with parenchymal venous congestion and edema
Causes of dural sinus thrombosis
Trauma, infection, inflammation, pregnancy, OCPs, dehydration, thyrotoxicosis, cirrhosis, coagulopathy, collagen-vascular disease, vasculitis (Behcets)
