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ICH / SAH

Neurology

QuestionAnswer
Most common parenchymal ICH: Hypertensive intracerebral hemorrhage
Most common parenchymal ICH: Hypertensive intracerebral hemorrhage
Primary ICH presentation HA, N/V; progressive hemiparesis & hemisensory def; HTN (on hx and on PE)
Primary hypertensive ICH: typical locations Thalamus; Basal Ganglia; Pons; Cerebellum
ICH presentation: Thalamus/ Basal Ganglia Contralateral Motor/ Sensory Deficit; Aphasia, Neglect; Depressed LOC with mass effect, IVC extension
ICH presentation: Cerebellum Ipsilateral Ataxia; Depressed LOC
ICH presentation: Pons Vertigo, Diplopia; Crossed signs; Depressed LOC
Amyloid angiopathy stroke: pathogenesis Blood vessel degeneration; Dementia; Lobar hemorrhage
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
Most common cause of subarachnoid bleed aneurysm
Subarachnoid bleed: Risk factors HTN; SMK; heavy EtOH; genetics (polycystic kidney dz; Ehlers-Danlos; if first-degree rel w/this stroke)
SAH stroke presentation Abrupt severe HA; meningismus; depressed LOC; nonfocal neuro exam
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
Hemorrhagic stroke: clinical manifestations Impaired LOC. Vomiting +/- HA. May cause progressive focal neuro deficit, depending on site of hemorrhage. Nuchal rigidity if SAH present
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
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.
Hemorrhagic stroke: Tx (ICH): surgical decompression for large hemorrhage with clinical deterioration
Hemorrhagic stroke: Tx (SAH): Nimodipine to decrease risk of vasospasm. Phenytoin for seizure Ppx. Endovascular or surgical correction to prevent rebleeding.
Hemorrhagic stroke: Tx (cerebral): venous thrombosis: requires anticoagulation with heparin
Cerebral aneurysm common features multiple aneurysms present in 20% of cases; typically occur anterior to Circle of Willis
ICH common features HTN usually cause if nontraumatic (often assoc with hemiplegia/hemiparesis); usually in basal ganglia; often older male
Head trauma, disoriented => lucid => coma Epidural Hematoma
Lens shaped hemorrhage Epidural Hematoma
Concave Subdural Hematoma
Sudden onset thunderclap HA, “worse HA of my life” Subarachnoid hemorrhage
Most common parenchymal ICH: Hypertensive intracerebral hemorrhage
Primary ICH presentation HA, N/V; progressive hemiparesis & hemisensory def; HTN (on hx and on PE)
Primary hypertensive ICH: typical locations Thalamus; Basal Ganglia; Pons; Cerebellum
ICH presentation: Thalamus/ Basal Ganglia Contralateral Motor/ Sensory Deficit; Aphasia, Neglect; Depressed LOC with mass effect, IVC extension
ICH presentation: Cerebellum Ipsilateral Ataxia; Depressed LOC
ICH presentation: Pons Vertigo, Diplopia; Crossed signs; Depressed LOC
Most common cause of subarachnoid bleed aneurysm
Subarachnoid bleed: RF HTN; SMK; heavy EtOH; genetics (polycystic kidney dz; Ehlers-Danlos; 1st-degree relative)
SAH stroke presentation Abrupt severe HA; meningismus; depressed LOC; nonfocal neuro exam; BP rises precipitously; poss temp to 39C
SAH etio: aneurysm nontraumatic: 75% saccular (berry) aneurysm, 50% mort; 5th-6th decade, M=F
aneurysm RFs SMK, HTN, high chol; PKD, coarct
Lucid interval seen in what trauma? epidural hematoma
subdural hematoma: blood source usu venous (bridging veins in space)
subdural hematoma: etiology Acceleration/ Deceleration injury; Veins transversing subdural space
NPH (chronic hydrocephalus) S/S: Incontinence, gait abnormalities, dementia
Subarachnoid hemorrhage may block __ causing hydrocephalus arachnoid villi
Acute subdural hematoma: timeframe Acute: 0-1 week
Chronic subdural hematoma: timeframe >2 weeks
Most common cause of SAH Trauma
Created by: Abarnard
 

 



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