problems with blood in the brain Flashcards
Stroke, TIA, subarachnoid haemorrhage, subdural haemorrhage, and extradural haemorrhage.
which arteries in the brain are likely to rupture in patients with HTN?
lenticular striate arteries (they have a very thin adventitia)
risk factors for stroke
heart disease
hypertension
diabetes mellitus
what percentage of strokes are embolic?
85%
what percentage of strokes are haemorrhagic?
10%
signs of intracerebral haemorrhage
sudden onset of stroke with raised intracranial pressure
signs of MCA stroke
receptive and expressive language areas arm and leg weak sensory loss hemianopia facial droop swallowing problems
signs of ACA stroke
leg symptoms
decrease in spontaneous speech
signs of PCA stroke
visual problems
complications of PCA stroke
prosopagnosia
other visual problems
complications of posterior circulation stroke
locked in syndrome
high death rate
during a stroke, the clock is ticking slower for which areas of the brain?
cortical areas
questions to ask when a patient has a stroke
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?
immediate management of stroke
diagnose stroke clinically
CT scan to rule out bleed
thrombolysis (check for contraindications first)
treatment of stroke
thrombolysis (alteplase - up to 4.5hrs) anti platelet drugs thrombectomy carotid endarterectomy statins anticoagulants antihypertensives surgery
risk management of stroke
platelet treatments
cholesterol treatments
AF treatments
antihypertensives
signs of posterior circulation stroke
motor deficit
speech and visual disturbance
pathology of transient ischaemic attack
sudden onset of global neurological deficit lasting less than 24 hours with complete clinical recovery (usually 5-15 minutes)
signs of TIA with carotid/anterior blockage
hemiparesis
amaurosis fugax (descending loss of vision in one eye)
Broca’s dysphagia
signs of TIA with vertebrobasilar/posterior blockage
hemisensory symptoms diplopia vertigo vomiting dysarthria (leading to slurred speech) ataxia hemianopia bilateral visual loss
treatment of TIA
clopidogrel
statins
risk factors for subarachnoid haemorrhage
polycystic kidney disease
coarctation of the aorta
pathology of subarachnoid haemorrhage
rupture of the arteries forming the circle of Willis - often because of berry aneurysms
signs of subarachnoid haemorrhage
thunderclap headache
photophobia
reduced consciousness
diagnosis of subarachnoid haemorrhage
CT head - white star shape from blood in the basal cisterns
treatment of subarachnoid haemorrhage
nimopidine - decreases arterial vasospasm
surgery - coiling (endovascular obliteration)
risk factors for subdural haemorrhage
alcoholic
dementia
being a baby
pathology of subdural haemorrhage
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
signs of subdural haemorrhage
meningism
signs of raised ICP
focal neuropathy - 3rd nerve palsy
complications of subdural haemorrhage
cardiac areas on brainstem may be pressed
diagnosis of subdural haemorrhage
CT head
treatment of subdural haemorrhage
osmotic diuresis with mannitol
Burr hole craniotomy
repair surgically
risk factors for extradural haemorrhage
trauma
fracture
pathology of extradural haemorrhage
bleeding from middle meningeal artery
lucid period
rapid rise in intracranial pressure
coning and death if not treated
signs of extradural haemorrhage
briefly unconscious, then lucid interval, then rapid deterioration
fixed dilated pupil (due to 3rd nerve palsy if herniation across midline)
complications of extradural haemorrhage
coning and death
diagnosis of extradural haemorrhage
CT head
treatment of extradural haemorrhage
osmotic diuresis with mannitol
clot evacuation ± ligation of bleeding vessel
