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ICH / SAH
Neurology
| Question | Answer |
|---|---|
| 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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