Vascular

Question 1

Describe the Modified Fisher Classification

Answer 1

0 - no SAH 1 - thin SAH (24% spasm) 2 - thin SAH with IVH (33% spasm) 3 - thick SAH no IVH (33% spasm) 4 - thick SAH with IVH (40% spasm)

Question 2

Describe the WFNS grade

Answer 2

1 - GCS 15 no deficit (10% bad outcome) 2 - GCS 13-14 no deficit (20% bad outcome) 3 - GCS 13-14 with deficit (40% bad outcome) 4 - GCS 7-12 (50% bad outcome) 5 - GCS 3-6 (70% bad outcome)

Question 3

Describe the mRS

Answer 3

Favourable 0 - asymptomatic 1 - no significant disability 2 - slight disability (independent) 3 - moderate disability (some dependency but can walk) Unfavourable 4 - unable to walk, dependent for ADLs 5 - vegetative 6 - dead

Question 4

Fatality of SAH?

Answer 4

50% (1:8 die outside hospital)

Question 5

Incidence of SAH?

Answer 5

6/100,000 per annum

Question 6

What are the modifiable risk factors for SAH?

Answer 6

Smoking Alcohol Hypertension

Question 7

What are 4 MCA segments?

Answer 7

Sphenoidal Insula Opercular Cortical

Question 8

Which aneurysms can cause IIIrd nerve palsies?

Answer 8

PCOM SCA Basilar tip Intracavernous ICA

Question 9

Describe contents of cavernous sinus?

Answer 9

OTOM CAT Rule

Question 10

Why is ICH common in basal ganglia or thalamus?

Answer 10

Supplied by perforators from large vessels (develop microaneurysms Charot-Bourchard aneurysms)

Question 11

Describe spetzler-martin grading?

Answer 11

Size

1-<3cm

2 = 3-6

3 >6

1 for deep venous drainage

1 for eloquence

Question 12

What is the rupture risk of unruptured AVM?

Answer 12

2% per year

Question 13

What is rupture risk of ruptured AVM?

Answer 13

Approx 10%

Question 14

Describe a classification for spinal AVMs?

Answer 14

Timo Krings

• Dural AV Shunt/AVF (radiculomeningeal feeding vessel)
• Pial AV Shunt
• Fistulous
• Glomus

Question 15

What’s haemorrhage risk for cranial cavernoma? (Over 5 years)

Answer 15

Depends on incidnental vs symptomatic and brainstem vs non brainstem

Incidental non-brainstem - 4%

Incidental brainstem - 8%

Symptomatic non-brainsteml - 20%

Symptomatic brainstem - 30%

Question 16

What is annual risk of AVM rupture?

Answer 16

2% unruptured

5% if previous ruptured

Question 17

What is risk rate for aneurysm rebleeding?

Answer 17

5% first 24-48 hours

20% first 2 weeks

Question 18

Describe STICH study?

Answer 18

Patietns with ICH randomised to either early clot evacuation (within 72 hoursf) or initial conservative treatment. Randomisation required equipoise by surgeon.

6 month follow up.

Question 19

What are components of ICH score?

Answer 19

GCS

Age > 80

ICH volume > 30

Intraventricular haemorrhage

Infratentorial origin of haemorrhage

Question 20

What should CSF protein and glucose be?

Answer 20

protein <0.4g/L

glucose > 1/2 serum