Neurology
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| Most common parenchymal ICH: | Hypertensive intracerebral hemorrhage
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| Most common parenchymal ICH: | Hypertensive intracerebral hemorrhage
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| Primary ICH presentation | HA, N/V; progressive hemiparesis & hemisensory def; HTN (on hx and on PE)
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| Primary hypertensive ICH: typical locations | Thalamus; Basal Ganglia; Pons; Cerebellum
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| ICH presentation: Thalamus/ Basal Ganglia | Contralateral Motor/ Sensory Deficit; Aphasia, Neglect; Depressed LOC with mass effect, IVC extension
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| ICH presentation: Cerebellum | Ipsilateral Ataxia; Depressed LOC
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| ICH presentation: Pons | Vertigo, Diplopia; Crossed signs; Depressed LOC
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| Amyloid angiopathy stroke: pathogenesis | Blood vessel degeneration; Dementia; Lobar hemorrhage
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| Amyloid angiopathy: presentation | Dementia; Episodic worsening; No h/ o HTN; poss acute limb weakness; BP 130/80 mmHg (less severe than in ICH); stroke d/t cerebral microhemorrhages
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| Most common cause of subarachnoid bleed | aneurysm
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| Subarachnoid bleed: Risk factors | HTN; SMK; heavy EtOH; genetics (polycystic kidney dz; Ehlers-Danlos; if first-degree rel w/this stroke)
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| SAH stroke presentation | Abrupt severe HA; meningismus; depressed LOC; nonfocal neuro exam
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| Hemorrhagic stroke: Etiologies | (1) Parenchymal (ICH) (90%): HTN (brainstem/cerebellum, basal ganglia); AVM; amyloid angiopathy (lobar); anticoag/thrombolysis; tumor (2) SAH (10%): ruptured aneurysm; trauma
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| Hemorrhagic stroke: clinical manifestations | Impaired LOC. Vomiting +/- HA. May cause progressive focal neuro deficit, depending on site of hemorrhage. Nuchal rigidity if SAH present
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| Hemorrhagic stroke: Dx studies | CT vs MRI. Angiography (CT or conventional) to determine source of bleed (aneurysm / AVM). LP to check for xanthochromia if no evidence of hemorrhage on CT & suspicion for SAH
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| Hemorrhagic stroke: Tx (general) | Reverse any coagulopathies. Keep platelets >100K. Recombinant activated Factor VII? Strict BP control (SBP <140) unless hypoperfusion risk 2/2 carotid art stenosis.
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| Hemorrhagic stroke: Tx (ICH): | surgical decompression for large hemorrhage with clinical deterioration
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| Hemorrhagic stroke: Tx (SAH): | Nimodipine to decrease risk of vasospasm. Phenytoin for seizure Ppx. Endovascular or surgical correction to prevent rebleeding.
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| Hemorrhagic stroke: Tx (cerebral): | venous thrombosis: requires anticoagulation with heparin
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| Cerebral aneurysm common features | multiple aneurysms present in 20% of cases; typically occur anterior to Circle of Willis
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| ICH common features | HTN usually cause if nontraumatic (often assoc with hemiplegia/hemiparesis); usually in basal ganglia; often older male
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| Head trauma, disoriented => lucid => coma | Epidural Hematoma
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| Lens shaped hemorrhage | Epidural Hematoma
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| Concave | Subdural Hematoma
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| Sudden onset thunderclap HA, “worse HA of my life” | Subarachnoid hemorrhage
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| Most common parenchymal ICH: | Hypertensive intracerebral hemorrhage
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| Primary ICH presentation | HA, N/V; progressive hemiparesis & hemisensory def; HTN (on hx and on PE)
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| Primary hypertensive ICH: typical locations | Thalamus; Basal Ganglia; Pons; Cerebellum
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| ICH presentation: Thalamus/ Basal Ganglia | Contralateral Motor/ Sensory Deficit; Aphasia, Neglect; Depressed LOC with mass effect, IVC extension
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| ICH presentation: Cerebellum | Ipsilateral Ataxia; Depressed LOC
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| ICH presentation: Pons | Vertigo, Diplopia; Crossed signs; Depressed LOC
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| Most common cause of subarachnoid bleed | aneurysm
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| Subarachnoid bleed: RF | HTN; SMK; heavy EtOH; genetics (polycystic kidney dz; Ehlers-Danlos; 1st-degree relative)
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| SAH stroke presentation | Abrupt severe HA; meningismus; depressed LOC; nonfocal neuro exam; BP rises precipitously; poss temp to 39C
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| SAH etio: aneurysm | nontraumatic: 75% saccular (berry) aneurysm, 50% mort; 5th-6th decade, M=F
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| aneurysm RFs | SMK, HTN, high chol; PKD, coarct
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| Lucid interval seen in what trauma? | epidural hematoma
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| subdural hematoma: blood source | usu venous (bridging veins in space)
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| subdural hematoma: etiology | Acceleration/ Deceleration injury; Veins transversing subdural space
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| NPH (chronic hydrocephalus) S/S: | Incontinence, gait abnormalities, dementia
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| Subarachnoid hemorrhage may block __ causing hydrocephalus | arachnoid villi
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| Acute subdural hematoma: timeframe | Acute: 0-1 week
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| Chronic subdural hematoma: timeframe | >2 weeks
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| Most common cause of SAH | Trauma
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Created by:
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