Vascular Events- Brain bleeds, LPs

Question 1

MC location of a berry aneurysm

Answer 1

Anterior communicating artery

Question 2

Two dz associated with berry (sacular) aneurysm

Answer 2

1. Autosomal dominant polycystic kidney dz

2. Ehlers-Danlos (NOT marfan)

Question 3

MCC of subarachnoid hemorrhage?

Answer 3

Trauma

Question 4

MCC of subarachnoid hem if not trauma? what is 2nd?

Answer 4

1. Ruptured aneurysm

2. ruptured AVM (arteriovenous malformation)

Question 5

Worst headache of life

Answer 5

subarachnoid hemorrhage

Question 6

workup for “worst HA of life”?

Answer 6

1. non contrast CT (look for blood)

2. LP (look for blood again)

Question 7

what is xanthanchromia, what does it indicate?

Answer 7

Yellowish coloration to CSF due to bilirubin (heme breakdown); indicative of a chronic subarachnoid hemorrhage (if bilirubin present, blood has been there for a while)

Question 8

medical tx for subarachnoid hemorrhage?

Answer 8

Nimodipine–> dihydropyridine CCB; helps prevent vasospasm, which occurs often after a subarach. bleed

Question 9

Sx tx for subarachnoid bleed?

Answer 9

Surgical clip

Question 10

lucid interval

Answer 10

epidural hematoma

Question 11

crescent-shaped on CT

Answer 11

subdural hematoma

Question 12

Charcot-bouchard microaneurysm–> where and what is likely cause?

Answer 12

small lenticulostriate vessels supplying basal ganglia and thalamus, or internal capsule–> HTN MCC
(can also be due to amyloid angiopathy, vasculitis, neoplasm, cocaine, or anticoagulant theapy)

Question 13

pt wakes up fro sleepinf with stroke symptoms due to thrombosis… candidate for tPA?

Answer 13

NO–> only if presents within 4.5 hours; must assume they had it right when went to sleep

Question 14

old person hits their head and present 3 days later with severe headache and vomiting

Answer 14

subdural hematoma–> common in alcoholics too due to cerebral atrophy

Question 15

*What 8 structures (in order) are passed during an LP

Answer 15

1. Skin
2. Superficial fascia
3. 3 ligaments (Supraspinatus, interspinatus, ligamentum flavum)
4. Epidural space
5. Dura mater
6. Arachnoid space
7. Subarachnoid space (where CSF is; where spinal anethesia in given)

Question 16

Where are LPs done

Answer 16

b/n L3-L4 (L3/L4 saves the cord)

*lower in children, because their spinal cord is lower

Question 17

landmark for doing LP

Answer 17

top of iliac crest is level of L4

Question 18

difference b/n stroke and TIA?

Answer 18

TIA symptoms resolve in 24 hrs

Question 19

4 areas most vulnerable to ishemia

Answer 19

1. cerebellum
2. neocortex
3. hippocampus
4. watershed areas

*watershed b/n MCA/ACA and MCA/PCA distribution; usually better off due to anastomosis in occlusion, but in hypotnesion, first to die

Question 20

CT reveals what in stroke workup

Answer 20

If hemorrhagic or not

Question 21

lenticulate or lens shaped (football) on CT

Answer 21

epidural hemotoma

Question 22

What CN lesion is frequently seen with epidural hematoma

Answer 22

CN III palsy–> dilated pupil esp.

*non working pupils without paralysis–> workup for aneurysm