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A. MLA Map Acute and Emergency > Subarachnoid/Subdural Haemorrhage > Flashcards

Subarachnoid/Subdural Haemorrhage Flashcards

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1
Q

Which 2 of the following blood vessels provide blood to the circle of willis in the brain?

1 - external carotid artery
2 - internal carotid artery
3 - vertebral artery
4 - subclavian artery

A

2 - internal carotid artery
3 - vertebral artery

  • forms dual supply incase of ischaemia
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2
Q

There are 3 main arteries that arise from the circle of willis. Which of the following is not one of these?

1 - anterior cerebral artery
2 - posterior cerebral artery
3 - anterior communicating artery
4 - middle cerebral artery

A

3 - anterior communicating artery

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3
Q

The 3 main arteries that come of the circle of willis are the anterior, posterior and middle cerebral arteries. Of these which supplies the temporal and parietal lobes?

A
  • middle cerebral artery
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4
Q

The 3 main arteries that come of the circle of willis are the anterior, posterior and middle cerebral arteries. Of these which supplies the frontal lobes and superior medial parietal lobes?

A
  • anterior cerebral artery
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5
Q

The 3 main arteries that come of the circle of willis are the anterior, posterior and middle cerebral arteries. Of these which supplies the following:

  • Medial surface of parietal lobe
  • Medial and inferior surface of temporal lobe including hippocampal formation
  • Occipital lobe
    Thalamus, hypothalamus and subthalamic nuclei
  • Midbrain
A
  • posterior cerebral artery
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6
Q

Which scoring tool is used to stratify the risk of a stroke in patients with AF?

1 - CHA2DS2-VASc score
2 - CURB score
3 - Q-risk score
4 - Modified Glasgow scale

A

1 - CHA2DS2-VASc score

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7
Q

An intracranial hemorrhage (ICH), also known as a intracranial bleed is bleeding within the skill and not the brain specifically. What group of patients is most at risk to an ICH?

1 - diabetics
2 - hypertensives
3 - obese
4 - previous cancer

A

2 - hypertensives

  • high pressure increases the risk of haemorrhage
  • vessels under high pressure are more likely to rupture
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8
Q

intracranial haemorrhage is bleeding within the cranium. A subclass of this is a subarachnoid hemorrhage (ICH). Where does this type of haemorrhage occur?

1 - between dura matter and cranium
2 - between dura and subarachnoid matter
3 - between subarachnoid and pia matter
4 - below the pia matter

A

3 - between subarachnoid and pia matter

  • sub = below
  • so bleeding below the subarachnoid and pia mater
  • not in the brain though
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9
Q

In an intra-cerebral haemorrhage, is it the superficial or deep structures that are affected?

A
  • deep structures
  • commonly cerebral hemispheres such as basal ganglia, thalamus
    – typically small haemorrhages, often associated with hypertension
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10
Q

What is a septic emboli?

A
  • an infected blood clot
  • such as sinusitis (swollen and inflamed sinuses)
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11
Q

Subarachnoid haemorrhage is bleeding into the space between the arachnoid and pia mater meninges. What is one of the most common causes of this?

1 - intracranial aneurysm
2 - head trauma
3 - infection
4 - medication

A

1 - intracranial aneurysm
- rupture of an intracranial aneurysm (weak blood vessel that bursts) or vascular malformation

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12
Q

Subarachnoid haemorrhage is is bleeding into the space between the arachnoid and pia mater meninges. The most common causes are a rupture of an intracranial aneurysm (weak blood vessel that bursts) or vascular malformation. What is the most common symptom of a subarachnoid haemorrhage?

1 - muscle weakness on one side of the body
2 - paralysis
3 - fever
4 - intense headache

A

4 - intense headache

  • bleeding increases pressure in the brain that presents as an intense headache
  • described as a thunderclap headache
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13
Q

Subarachnoid haemorrhage is bleeding into the space between the arachnoid and pia mater layers of the meninges. One of the most common causes is a rupture of an intracranial aneurysm (weak blood vessel that bursts) or vascular malformation. The most common symptom of a subarachnoid haemorrhage is a severe acute headache, called a thunderclap headache. What can happen if this is missed?

1 - nothing artery eventually clots
2 - patient may have a permanent headache
3 - continue bleeding increases ICP causing brain damage and even death
4 - all of the above

A

3 - continue bleeding increases ICP causing brain damage and even death

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14
Q

The following are all clinical features if which main artery was occluded?

  • Contralateral hemiplegia and facial weakness
  • Contralateral sensory loss
  • Dysphasia (dominant hemisphere)
  • Contralateral neglect (especially nondominant parietal lobe)
  • Dysarthria, dysphagia
  • Eye deviation away from affected side

1 - anterior cerebral artery
2 - middle cerebral artery
3 - vertebral artery
4 - posterior cerebral artery

A

1 - anterior cerebral artery

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15
Q

The following are all clinical features if which main artery was occluded?

  • Vertigo, vomiting
  • Ataxia
  • Dysarthria, dysphagia
  • Ophthalmoplegia, diplopia
  • Homonymous hemianopia
  • Altered consciousness
  • Cranial nerve palsies

1 - anterior cerebral artery
2 - middle cerebral artery
3 - vertebral artery
4 - posterior cerebral artery

A

4 - posterior cerebral artery

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16
Q

Why is addressing obesity an important modification of risk stroke?

A
  • lots of risk factors for stroke
  • increased risk of CVD, diabetes and hypertension
  • all increase the risk of stroke
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17
Q

When you suspect a stroke, what imaging modality must be used?

1 - CT and/or MRI imaging
2 - ultrasound
3 - PET scan
4 - all of the above

A

1 - 1st CT and/or MRI imaging

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18
Q

When you suspect a stroke, what imaging modality must be used when we would want to investigate vascular pathology?

1 - CT
2 - MRI imaging
3 - MRI angiogram
4 - ultrasound

A

3 - MRI angiogram
- MRI that focusses on blood vessels

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19
Q

When you suspect a stroke, what imaging modality must be used if we suspect carotid stenosis due to a potential thrombosis?

1 - CT
2 - MRI imaging
3 - MRI angiogram
4 - carotid doppler

A

4 - carotid doppler

- doppler would identify a blockage of an blood vessel

20
Q

When you suspect a stroke, what modality must be used if we suspect atrial fibrillation?

1 - ECG
2 - MRI imaging
3 - MRI angiogram
4 - carotid doppler

A

1 - ECG and cardiac monitoring

  • blood pressure monitoring
  • full blood counts
21
Q

What is homonymous hemianopia?

1 - complete loss in one eye
2 - loss of temporal fields in both eyes
3 - loss of nasal and temporal visual fields
4 - loss of everything except the macula

A

3 - loss of nasal and temporal visual fields
- e.g.: left eye loses nasal field and right eye loses temporal field

  • hemi = greek for half
  • an = greek for without
  • opsia = greek for seeing
22
Q

What does dysphasia mean?

1 - partial loss of language
2 - inability to understand speech
3 - loss of language when speaking
4 - loss of language and ability to speak

A

1 - partial loss of language

  • dys = greek for difficult
  • phaots = spoken
23
Q

Dysphasia means means partial loss of language. Which 2 parts of the brain is crucial for speech?

1 - brodmann areas 22, 44 and 45
2 - brodmann areas 1, 2 and 3
3 - brodmann areas 4 and 17
4 - brodmann area 6

A

1 - brodmann areas 22, 44 and 45

  • Wernicke’s area = brodmann area 22
  • Brocas area = brodmann areas 44 and 45
24
Q

A patient presents with sudden onset right sided weakness and dysphasia, dense right face/arm/leg weakness, sensory loss, severe mixed dysphasia and right homonymous. Out of the following, which diagnosis would she have?

1 - Total anterior circulation syndrome (TACS)
2 - Partial anterior circulation stroke (PACS)
3 - Lacunar strokes (LACS)
4 - Posterior Circulation Stroke Syndromes (POCS)

A

1 - TACS because she has all 3 clinical presentations

1 = unilateral motor weakness
2 = higher cortical deficit
3 = homonymous visual field defect

25
Q

A patient presents with sudden onset right sided weakness and dysphasia, dense right face/arm/leg weakness, sensory loss, severe mixed dysphasia and right homonymous and is diagnosed with Total anterior circulation syndrome (TACS). She attends A&E within an hour of the symptoms starting, from the following treatments, which would be most appropriate?

1 - Aspirin and IV fluids and admit to stroke ward
2 - Thrombolysis only (plasminogen activator (tPA))
3 - Thrombectomy only
4 - Thrombolysis and thrombectomy

A

2 - Thrombolysis only with plasminogen activator (tPA)
- only good if within the first 4.5 hours of symptoms starting

26
Q

Does the image below show an ischaemic or haemorrhagic stroke?

A
  • haemorrhagic stroke
  • white area is a bleed
27
Q

Does the image below show an ischaemic or haemorrhagic stroke?

A
  • blood clot so ischaemic
28
Q

A patient presents with a left temporoparietal haemorrhage, and presents with speech disturbance, loss of balance on the right side and right homonymous hemianopia. She also has a history of hypertension, atrial fibrillation and is on warfarin. What is likely to be causing the haemorrhage?

1 - trauma from a fall
2 - hypertension
3 - obesity
4 - infection

A

2 - hypertension

  • increased pressure in brain due to hypertension
  • bleed made worse by blood thinning (warfarin)
29
Q

A patient presents with a left temporoparietal haemorrhage, and presents with speech disturbance, loss of balance on the right side and right homonymous hemianopia. She also has a history of hypertension, atrial fibrillation and is on warfarin. Increased pressure in brain due to hypertension has likely made the blood vessels weak, hence the haemorrhage, and the bleed is made worse by blood thinning (warfarin). Which of the following are important treatment options must be used on this patient?

1 - Aspirin and IV fluids and admit to stroke ward
2 - Thrombolysis only (plasminogen activator (tPA))
3 - prothrombin complex, vitamin K and surgery
4 - Thrombectomy

A

3 - prothrombin complex, vitamin K and surgery
- surgery to relieve the pressure

30
Q

In the image below, we can see an embolism. Which of the following would this be based on the image below?

1 - Total anterior circulation syndrome (TACS)
2 - Partial anterior circulation stroke (PACS)
3 - Lacunar strokes (LACS)
4 - Posterior Circulation Stroke Syndromes (POCS)

A

3 - LACS as its small in deep brain tissue

  • pure motor function would be affected
  • deep brain tissue affected
31
Q

If a patient presents with the following, which type of stroke is this likely to be?

  • Pure motor deficit
  • Pure sensory deficit
  • Ataxic hemiparesis
  • Sensorimotor stroke
  • Dysarthria-clumsy hand syndrome

1 - TACS
2 - PACS
3 - LACS
4 - POCS

A

3 - LACS

32
Q

In the image below, we can see an embolism due to a Lacunar strokes (LACS). We know this because the presenting patient only had motor function affected and we can see it is in the deep brain tissue that is affected. The patient was fine the night before but found collapsed the next day, what would be his initial treatment option?

1 - Aspirin and IV fluids and admit to stroke ward
2 - Thrombolysis only (plasminogen activator (tPA))
3 - prothrombin complex, vitamin K and surgery
4 - Thrombectomy

A

1 - Aspirin and IV fluids and admit to stroke ward

  • aspirin at 300mg
  • > 4.5h so no to tPA
  • > 6h and not proximal anterior circulation large vessel occlusion so no to thrombectomy
33
Q

What does photophobic mean?

A
  • photo = light
  • phobia = fear of
  • sensitivity to light
34
Q

What can we see on the head CT-scan below?

1 - migraine
2 - TACS
3 - embolism
4 - haemorrhage

A

1 - migraine

35
Q

If a patient presents with dysphasia (speech difficulty) and sensitivity to light, and has been off work previously due to severe headaches, is this likely to be a stroke or migraine?

A
  • migraine
  • can mimic a stroke
  • can be triggered by stress, change of diet, hormonal changes, weather, alcohol etc
36
Q

A 45 year old patient presents with left facial weakness involving the whole of left side of face, including the forehead and with incomplete closure of left eye. Has had a recent infection of sinuses and symptoms have been present for a few days. Is the diagnosis likely to be some form of a stroke or bells palsy?

A
  • bells palsy
  • affects CN VII (7) the facial nerve
  • damage to or in infection of CN VII can cause bells palsy
  • we can distinguish because bells palsy is a lower motor neuron problem
37
Q

Although the cause of bells palsy is unknown, what is the most common precipitating factor that it has been linked with it?

1 - viral infection of sinuses
2 - trauma
3 - stroke
4 - hypertension

A

1 - viral infection of the sinuses

38
Q

What does the image below show?

1 - TACS
2 - PACs
3 - left occipital tumour
4 - haemorrhage

A

3 - left occipital tumour
- can see different structure in occipital region

39
Q

What are some of the most common things that can mimic a stroke that we need to be aware of?

1 - Seizures
2 - Tumour
3 - Migraine
4 - Bells palsy
5 - Hypoglycaemia
6 - Infection (and cerebral hypoperfusion)
7 - Subdural haemorrhage
8 - Functional disorder
9 - all of the above

A

9 - all of the above

40
Q

What is aphasia?

1 - partial loss of language
2 - inability to understand speech
3 - loss of language when speaking
4 - loss of language and ability to speak

A

3 - loss of language when speaking

41
Q

When trying to distinguish between an infarct and haemorrhage on a MRI, which appears hypo and hyperdense?

A
  • infarct = hyperdense so appears brighter
  • haemorrhage = hypodense so appears darker
42
Q

When trying to distinguish between an infarct and haemorrhage on a CT, which appears hypo and hyperdense?

A
  • infarct = hypodense so appears darker
  • haemorrhage = hyperdense so appears brighter
43
Q

What is the 1st line imaging in a patient with suspected subarachnoid haemorrhage SH?

1 - head CT
2 - head MRI
3 - head X-ray
4 - head CT with contrast

A

1 - head CT

Should be performed asap with best sensitivity when performed in <6 hours

> 6 hours, CT cannot exclude SH

44
Q

Xanthocromia, which means yellow colour, is the presence of yellow products in the CSF following a lumbar puncture. Where does the yellow colour come from?

1 - damage dura mater
2 - damaged pia mater
3 - haemoglobin catabolism
4 - neutrophil deposition

A

3 - haemoglobin catabolism

Rupture of RBCs following subarachnoid haemorrhage.

Yellow colour comes from bilirubin

CSF sample must be protected from light!!!!

45
Q

Is a CT angiogram useful in a patient with a subarachnoid haemorrhage (SH)?

A
  • No

Can identify an aneurysm, but hard to tell if this has ruptured or is not the cause of the SH

46
Q

In a patient with a subarachnoid haemorrhage (SH), we should always refer to neurology. We should also give which drug?

1 - nimodipine
2 - bisoprolol
3 - propofol
4 - sumatriptan

A

1 - nimodipine
Acts on Ca2+ channels and inhibits vasoconstriction and vasospasm of blood vessels

Also need to clip or coil the aneurysm causing the SH

47
Q

In a patient with a subarachnoid haemorrhage, we should always refer to neurology. We should also treat with the 3 Hs. Which of the following is NOT one of these?

1 - hypervolaemia
2 - hypertension (avoid hypotension)
3 - hyperventilation
4 - haemodilution

A

3 - hyperventilation

A. MLA Map Acute and Emergency (42 decks)

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