Radiology Bleeds Flashcards
intraparenchymal hemorrhagic strokes (IPH): etio. patho. most common location. RF. causes.
10-20% strokes. due to rupture of small, penetrating arteries weaker by chronic HTN = biggest modifiable RF. most common location: BG - especially putamen, pons, cerebellum, thalamus. other RF- low serum cholesterol. more common in asian and AA. M>W. anticoagulants = most common iatrogenic cause. cerebral amyloid angiopathy incr hemorrhage risk for pt on anticoag. many fatal. alcohol, smoking sympathomimetic drugs ~ cocaine/ amphetamine incr risk bc lead to vasculitis or produce acute rises in BP –> rupture of preexisting vascular abn.
IPH v ischemic events
can’t be reliably DD clinically. some dif: ischemic stroke- immediate onset. IPH- 30-90min. IPH hematoma expansion is unusual after 24hr. IPH more associated with decrease lvl of counciousness, HA, N/V due to mass effect of rapidly expanding hematoma –> incr ICP. IPH do not respect well demarcated vascular territories.
IPH presenting sx
CL hemiplegia and sensory deficit due to mass effect on internal capsule. larger hemorrhage may cause aphasia or neglect, visual disturbances, dear lvl of consciousness, progress to coma escpially if mass effect is on brainstem. eventually hydrocephalus may result to long term cog impairment. may expand to ventricular system- decr consciousness, severe HA, N/V
pontine hemorrhage
often fatal. rupture of penetrating vessels that emerge from basilar and travel into pons. quickly quadriplegic with rigidity and decerebrate posturing. typically comatose with min brainstem reflexes. pin-pt pupils.
cerebellar hemorrhage. presenting hx. etio
10% IPH. present with HA, gait ataxia, vertigo/ dizziness, V. may dev acute lethal obstructive hydrocephalus due to occlusion of 4th ventricle.
cerebrellar hemorrhage CT
enlarged temporal horns of lateral ventricle. if hematoma >3cm- at risk for neuro decline so neurosurgical evaculation. <3cm - monitor clinically and radiographically
fatal gastroenteritis
N/V due to unrecognized cerebellar pathology (hemorrhage) that kills pt. so releasing ICP by external ventricular drain can be lifesaving.
IPH clinical course
monitor closely to respiratory and circulatory status. intubate if can’t protect airway due to brainstem dysfunc or depressed lvl of consciousness. most common cause of decline is early hematoma expansion which is in 40% pt. freq ck neuro function radio f/u to monitor hematoma expansion. pt with large hematoma- place intraventricular monitor to measure ICP. high ICP- drain with intraventricular catheter. decr ICP: mannitol, hyperventilation in pt with impending herniation. pt with intracerebral hemorrhage while on anti-coag should be given it K and either FFP or recombinant F VIIa to help dear hematoma expansion.
lobar hemorrhage: define: etio
hemorrhage within lobes of brain adj to cortex. in elderly, non-HTN pt, often see seizure. seen in pt with cerebral amyloid amyloid antipathy. occur when accumulate amyloid in arterioles of cortex and meninges. usually simultaneous hemorrhages. more common in parietal and occipital. RF: e2 or e4 allele of apolipoprotein E gene.
tx of high BP
SBP> 200: or MAP>150: continuous IV infusion with freq BP q5min.
SBP >180 or MAP>130 + evidence of incr ICP- monitor ICP and decor BP with intermittent or continuous IV meds. maintain cerebral perfusion P >60-80.
SBP>180 or MAP>130 and no evidence of incr ICP then modest reduction of BP, MAP target 110. or 160/90. BP ck q15min
high BP complications
infection, DVT, electrolyte disturbances
CAA
usually spares BG, brainstem, cerebellum. dx. pathological examination blood vessel. stain with congo red dye. yellow-green bifringence under polarized light. CT> MRI. no tx. avoid antiplt and anticoag med.
slit like cavity
seen on axial flair of remote hemorrhages. secondary to hold hemorrhage
ischemic stroke v TPA
especially after TPA, is a case of IPH. rate of hemorrhage with TPA use is 6%.
high grade primary brain neoplasm
like glioblastoma, oligodendrgliomas, craniopharyngioma, pituitary adenoma, choroid plexus carcinoma. often hemorrhage into necrotic center of tumor. hemorrhage often is presenting sx of such tumors. in kids: medulloblastoma associated with hemorrhage. lower grade= less likely to hemorrhage.
