Stroke Guidelines Hemorrhagic Stroke Flashcards
Microaneurysms in the brain are also known as?
Charcot-Brouchard aneurysms
Common sites of arterial hemorrhages
Putamen Caudate Pons Cerebellum Thalamus Deep white matter
In no particular order
Most common sites of hypertensive intraparenchymal hemorrhage
- Putamen and internal capsule - 50%
- Thalamus - 15%
- Lobar - 15%
- Pons - 10%
- Cerebellum - 10%
After how many months is the hemorrhage generally resolved to a slitlike orange cavity?
1-6 months
For warfarin related
ICH what is the management?
Stop warfarin
IV vit K
FFP transfusion
Normoglycemia is important in ICH patients what is the target CBG?
110-180 mg/dl
When is it safe to give low dose LMWH or UH for immobile ICH patients to prevent thromboembolism?
After 1-4 days of ICH onset
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?
No
Non- surgicla candidtates
- <10 ml
- GCS < 5
- Pontine or mid-brain hemorrhage
A patient came in. The CT scan revealed cerebellar hemorrhage 3.5 ml. What is the next step?
Refer to neuro surgery for decompression
Candidates for surgery?
- Cerebellar bleed > 3ml
- Bleed associated with: aneurysm, AV mal, cavernous angioma
- Clinically deteriorating, young, moderate to large bleed
- Intraventricular extension with mod to severe hydroceph
Patient is GCS 6 with basal ganglia hemorrhage. Folks asked you if surgery is still an option. What is your response?
Yes
May benefit from surgery
- Basal ganglia or thalamic
- GCS 5 and above
- Supratentorial hematoma > 30 cc
CT scan for SAH is most sensitive during what time period?
12 hours - 98-100% sensitive
Gold standard for the determination of the cause of SAH?
Cerebral angiography
If negative repeat after 7-14 days
What is the target BP for ICH patients ?
MAP 100
SBP - approx 160
140 safe but efficacy is to be determined
One of the early specific treatment for SAH is giving calcium channel blockers. What is this drug?
Nimodipine 60 mg Q4 for 3 weeks
What is the reasonable target BP for SAH patients pre-op?
<150 mmHg is reasonable
Method recommended for monitoring vasospasm in SAH?
Serial Trascranial Doppler
What is the main goal of
SAH treatment?
Obliteration of aneurysm
Early surgery for SAH is ideally performed when?
Within 72 hours
Hunt and Hess or WFNS grade for early immediate surgery?
Grade I-III
Advanced age in a patient with CKD who had SAH is a contraindication for coiling.
True or false?
True. Only those with advanced age but with no organ failure is recommended for surgery
A poor grade V SAH patient presented, noted vasopasm on TCD. Folks asked if coiling can be performed. What is your response?
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
Of all subtypes of vascular malformation what is the most aggressive?
AVM
For symptomatic avm, what is the most common presentation in 50% of cases?
Hemorrhage
Followed by seizures
Gold standard for diagnosis of AVM?
Cerebral catheter angiography or DSA ( disgital subtraction angiography)
