Strokes

Question 1

Epidural Hemorrhage

Answer 1

TRAUMA (assoc with skull fracture)
Tearing of middle meningeal artery
High pressure bleend (arterial)
LUCID INTERVAL (then LOC with increasing ICP)
Surgical drainage required

Question 2

Subdural Hemorrhage

Answer 2

Most commonly traumatic, even mild
Tearing of bridging veins in subdural space
Low pressure bleed (venous)
More common in elderly (with atrophic brains so more space between brain and dura

Question 3

Aneurysmal Subarachnoid hemorrhage SAH

Answer 3

WHOL
usually trauma but if not then aneurysm (saccular, AComm>PComm)
Sometimes focal deficit
Altered consciousness
Sudden death in 1/3 (due to sympathetic surge –> cardiac arrhythmia, hydroceophalus due to involvement of ventricular system)
TREAT: clipping to occlude blood flow, coiling (less invasive)

Question 4

Arteriovenous Malformation

Answer 4

abnormal connection between artery and vein (usually would diffuse in cap bed, but AM results in no diffusion of arterial pressure before flow hits vein)
PRESENTS: hemorrhage, seizure, often found incidentally
TREAT: just watch it, surgery, or interventional radioliogy
Higher score on Spetzler-Martin is worse surgical candidate

Question 5

Intracerebral Hemorrhage

Answer 5

Acute focal neuro deficit, decreased LOC, vomiting, headaches
LOCATIONS: cerebral lobes, basal ganglia, thalamus, pons, cerebellum

Question 6

Large Vessel MCA

Answer 6

hemiparesis, hemisesnory deficit, hemianopsia
Aphasia (dominant)
Neglect (non-dominant)

Question 7

Large Vessel ACA

Answer 7

No pain, all of sudden!, think LEGS

Question 8

Causes in Young (non-Atherosclerotic)

Answer 8

Hemo: protein C/S/antithrombin
Antiphospholipid Ab syndrome (lupus)
Malignancy
Oral contraceptives, post partum
Sickle cell anemia
EtOH
Stimulants
Inactivity/obesity
Congential and acquired heart defects
PLUS: Arterial dissection common in young and active
Moya-Moya - puff of smoke on CT
Intramuscular dysplasia (cheeto!)

Question 9

TIA

Answer 9

brief episode of focal neuro deficit but has clinical symptoms of less than an hour, does not last long enough to kill the part of the brain

Question 10

Small Vessel: Lacuna

Answer 10

Strokes less then 1cm
SUB - cortical
Face, arm and leg on same side (she called it symmetry)

Question 11

Large Vessel PCA

Answer 11

vision, cerebellar signs (eg balance, clumsiness)