problems with blood in the brain

Question 1

which arteries in the brain are likely to rupture in patients with HTN?

Answer 1

lenticular striate arteries (they have a very thin adventitia)

Question 2

risk factors for stroke

Answer 2

heart disease
hypertension
diabetes mellitus

Question 3

what percentage of strokes are embolic?

Answer 3

85%

Question 4

what percentage of strokes are haemorrhagic?

Answer 4

10%

Question 5

signs of intracerebral haemorrhage

Answer 5

sudden onset of stroke with raised intracranial pressure

Question 6

signs of MCA stroke

Answer 6

receptive and expressive language areas
arm and leg weak 
sensory loss
hemianopia
facial droop 
swallowing problems

Question 7

signs of ACA stroke

Answer 7

leg symptoms

decrease in spontaneous speech

Question 8

signs of PCA stroke

Answer 8

visual problems

Question 9

complications of PCA stroke

Answer 9

prosopagnosia

other visual problems

Question 10

complications of posterior circulation stroke

Answer 10

locked in syndrome

high death rate

Question 11

during a stroke, the clock is ticking slower for which areas of the brain?

Answer 11

cortical areas

Question 12

questions to ask when a patient has a stroke

Answer 12

is there bleeding?
yes - has a blood vessel ruptured?
no - is a blood vessel blocked?

is the blood supply reduced?

is the brain tissue injured?

Question 13

immediate management of stroke

Answer 13

diagnose stroke clinically

CT scan to rule out bleed

thrombolysis (check for contraindications first)

Question 14

treatment of stroke

Answer 14

thrombolysis (alteplase - up to 4.5hrs)
anti platelet drugs
thrombectomy
carotid endarterectomy
statins
anticoagulants
antihypertensives
surgery

Question 15

risk management of stroke

Answer 15

platelet treatments
cholesterol treatments
AF treatments
antihypertensives

Question 16

signs of posterior circulation stroke

Answer 16

motor deficit

speech and visual disturbance

Question 17

pathology of transient ischaemic attack

Answer 17

sudden onset of global neurological deficit lasting less than 24 hours with complete clinical recovery (usually 5-15 minutes)

Question 18

signs of TIA with carotid/anterior blockage

Answer 18

hemiparesis
amaurosis fugax (descending loss of vision in one eye)
Broca’s dysphagia

Question 19

signs of TIA with vertebrobasilar/posterior blockage

Answer 19

hemisensory symptoms
diplopia
vertigo 
vomiting
dysarthria (leading to slurred speech)
ataxia
hemianopia
bilateral visual loss

Question 20

treatment of TIA

Answer 20

clopidogrel

statins

Question 21

risk factors for subarachnoid haemorrhage

Answer 21

polycystic kidney disease

coarctation of the aorta

Question 22

pathology of subarachnoid haemorrhage

Answer 22

rupture of the arteries forming the circle of Willis - often because of berry aneurysms

Question 23

signs of subarachnoid haemorrhage

Answer 23

thunderclap headache
photophobia
reduced consciousness

Question 24

diagnosis of subarachnoid haemorrhage

Answer 24

CT head - white star shape from blood in the basal cisterns

Question 25

treatment of subarachnoid haemorrhage

Answer 25

nimopidine - decreases arterial vasospasm

surgery - coiling (endovascular obliteration)

Question 26

risk factors for subdural haemorrhage

Answer 26

alcoholic
dementia
being a baby

Question 27

pathology of subdural haemorrhage

Answer 27

bleeding from bridging veins - low pressure so soon stops
days/weeks later the haematoma starts to autolyse –> high increase in oncotic pressure as water is sucked into haematoma –> gradual rise in ICP

Question 28

signs of subdural haemorrhage

Answer 28

meningism
signs of raised ICP
focal neuropathy - 3rd nerve palsy

Question 29

complications of subdural haemorrhage

Answer 29

cardiac areas on brainstem may be pressed

Question 30

diagnosis of subdural haemorrhage

Answer 30

CT head

Question 31

treatment of subdural haemorrhage

Answer 31

osmotic diuresis with mannitol
Burr hole craniotomy
repair surgically

Question 32

risk factors for extradural haemorrhage

Answer 32

trauma

fracture

Question 33

pathology of extradural haemorrhage

Answer 33

bleeding from middle meningeal artery
lucid period
rapid rise in intracranial pressure
coning and death if not treated

Question 34

signs of extradural haemorrhage

Answer 34

briefly unconscious, then lucid interval, then rapid deterioration
fixed dilated pupil (due to 3rd nerve palsy if herniation across midline)

Question 35

complications of extradural haemorrhage

Answer 35

coning and death

Question 36

diagnosis of extradural haemorrhage

Answer 36

CT head

Question 37

treatment of extradural haemorrhage

Answer 37

osmotic diuresis with mannitol

clot evacuation ± ligation of bleeding vessel