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Guidelines > Stroke Guidelines Hemorrhagic Stroke > Flashcards

Stroke Guidelines Hemorrhagic Stroke Flashcards

1
Q

Microaneurysms in the brain are also known as?

A

Charcot-Brouchard aneurysms

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2
Q

Common sites of arterial hemorrhages

A 
Putamen
Caudate
Pons
Cerebellum
Thalamus
Deep white matter

In no particular order

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3
Q

Most common sites of hypertensive intraparenchymal hemorrhage

A
  1. Putamen and internal capsule - 50%
  2. Thalamus - 15%
  3. Lobar - 15%
  4. Pons - 10%
  5. Cerebellum - 10%
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4
Q

After how many months is the hemorrhage generally resolved to a slitlike orange cavity?

A

1-6 months

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5
Q

For warfarin related

ICH what is the management?

A

Stop warfarin

IV vit K

FFP transfusion

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6
Q

Normoglycemia is important in ICH patients what is the target CBG?

A

110-180 mg/dl

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7
Q

When is it safe to give low dose LMWH or UH for immobile ICH patients to prevent thromboembolism?

A

After 1-4 days of ICH onset

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8
Q

A patient presented with ICH of 8 cc with slurring of speech and 3/5 weakness of the affected side. Should you refer to neuro- surgery?

A

No

Non- surgicla candidtates

  1. <10 ml
  2. GCS < 5
  3. Pontine or mid-brain hemorrhage
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9
Q

A patient came in. The CT scan revealed cerebellar hemorrhage 3.5 ml. What is the next step?

A

Refer to neuro surgery for decompression

Candidates for surgery?

  1. Cerebellar bleed > 3ml
  2. Bleed associated with: aneurysm, AV mal, cavernous angioma
  3. Clinically deteriorating, young, moderate to large bleed
  4. Intraventricular extension with mod to severe hydroceph
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10
Q

Patient is GCS 6 with basal ganglia hemorrhage. Folks asked you if surgery is still an option. What is your response?

A

Yes

May benefit from surgery

  1. Basal ganglia or thalamic
  2. GCS 5 and above
  3. Supratentorial hematoma > 30 cc
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11
Q

CT scan for SAH is most sensitive during what time period?

A

12 hours - 98-100% sensitive

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12
Q

Gold standard for the determination of the cause of SAH?

A

Cerebral angiography

If negative repeat after 7-14 days

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13
Q

What is the target BP for ICH patients ?

A

MAP 100

SBP - approx 160

140 safe but efficacy is to be determined

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14
Q

One of the early specific treatment for SAH is giving calcium channel blockers. What is this drug?

A

Nimodipine 60 mg Q4 for 3 weeks

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15
Q

What is the reasonable target BP for SAH patients pre-op?

A

<150 mmHg is reasonable

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16
Q

Method recommended for monitoring vasospasm in SAH?

A

Serial Trascranial Doppler

17
Q

What is the main goal of

SAH treatment?

A

Obliteration of aneurysm

18
Q

Early surgery for SAH is ideally performed when?

A

Within 72 hours

19
Q

Hunt and Hess or WFNS grade for early immediate surgery?

A

Grade I-III

20
Q

Advanced age in a patient with CKD who had SAH is a contraindication for coiling.
True or false?

A

True. Only those with advanced age but with no organ failure is recommended for surgery

21
Q

A poor grade V SAH patient presented, noted vasopasm on TCD. Folks asked if coiling can be performed. What is your response?

A

Yes
Coiling can be done for both poor and good grade patients

Vasospasm is not a contraindication

Can be done with local anes if needed

22
Q

Of all subtypes of vascular malformation what is the most aggressive?

A

AVM

23
Q

For symptomatic avm, what is the most common presentation in 50% of cases?

A

Hemorrhage

Followed by seizures

24
Q

Gold standard for diagnosis of AVM?

A

Cerebral catheter angiography or DSA ( disgital subtraction angiography)

25
Q

What is the management for asymptomatic AVM 4.5 cm in diameter?

A

Observe if asymptomatic and offer elective surgery

26
Q

SM grading revealed a score of 4 what is the treatment option?

A

Conservative/ paliative

SM 1-2 AVM excision if family consents

SM 3 multimodality approach

27
Q

Cushings triad is comprised of?

A

Hypertension
Bradycardia
Irregular RR

28
Q

Serum osmolality required for osmotic therapy of increased ICP?

A

300-320 mosmol/kg

29
Q

Hyperventilation is a maneuver done for impending herniation. What is the target PCO2?

How long is this effect?

A

PCO2 30-35

Effect short lived approx 6 hours

30
Q

For patients with GCS <8, with hydroceph or IVH CPP should be maintained to?

A

60-70

Normal is 70-100

31
Q

Most common site of intracranial saccular aneurysm

A

ACOm and ACA junction

Guidelines (5 decks)

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