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19 Cards in this Set
- Front
- Back
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What are the common causes of hemorrhagic stroke?
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-intracerebral bleeding due to HYPERtension and amyloid angiopathy (amyloid ( are insoluble fibrous protein aggregates ) deposits form in the walls of the BV's)
-subarachnoid hemorrhage (ie aneuryism- localized, blood-filled balloon-like bulge in the wall of a blood vessel) -trauma -other structural abnormality |
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How would a pt. present with a intracerebral hemorrhage? Where do the bleeds most likely occur?
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-small penetrating arteries are damaged by prolonged hypertension
-putamen, thalamus, pons and cerebellum |
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How would a pt. present with a putaminal hemorrhage?
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-similar to occlusionof middle cerebral artery
-contralateral hemiplegia and hemianesthesia (loss of sensation on one part ofthe body), homonymous hemianopsia (visual field loss that respects the vertical midline), gaze prefrence towards side of lesion, aphasia (if on dominant side), hemineglect (if on non dominant side), alteration in consciousness |
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How would a pt. present with a thalamic hemorrhage?
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-contralateral hemiparesis (weakness on one side of the body) and hemianesthesia
-sensory loss may be greater than motor deficit -eyes may deviate away from lesion (wrong way eyes) -restriction of upward gaze (forced downward deviation) -alteration of consciousness - |
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How would a pt. present with pontine hemorrhage?
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-early coma
-pinpoint pupils that react to light -impaired or absent response to caloric testing -decebreate posturing (involuntary extension of arms and legs) |
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How would a patient present with a cerebellar hemorrhage?
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-sudden onset of dizziness and vomiting!
-truncal ataxia -no significant alteration of consciousness early -MAY SHOW SIGNS of ipsilateral pontine compression (gaze preference toward side of the lesion, ipsilateral facial weakness, diminshed corneal reflex on affected side |
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What is a common cause of intracerebral hemorrhage in the elderly?
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-amyloid angiopathy
-bleeds tend to be lobular (aka not deep) |
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How does one manage intracerebral hemorrhages?
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-ABCs
-treat edema, elevate head at least 30-45 deg. -hyperventilation -possible surgical evacuation |
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What is the deterioration of patients with stroke often due to? What is cerebral perfusion pressure?
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-increased intracraniel pressure due
- mean arterial pressure - intracranial pressure (cerebral perfusion pressure is what we worry about most!!) |
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What is cushings triad of increased intracrainal pressure?
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-hypertension, bradycardia, respiratory irregulatiies (not all exhibit the full triad)
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Describe vasogenic edema? what does edema assoc. with neoplasms usually respond to?
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-affects white matter, usually assoc with neoplasms, stroke and infection
-corticosteroids! |
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Define cytotoxic edema?
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-affects grey matter, usually assoc. with trauma
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What do uncal herniations usually result form? What are early signs of this? Late signs?
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-a laterally placed mass displacing the brain stem contralaterally and pushing the uncus of thetemporal lobe medially over the tentorial edge
-early: ipsilateral pupillary dilation -late: complete ipsilateral third nerve palsy, loss of consciousness, contralateral or ipsilateral hemiplegia, flaccid paralysis |
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What do tonsillar herniations result from? What are symptoms of this?
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-downward displacement ofthe cerebellar tonsils through the foramen magnum (like chiari type 1?)
-neck pain, respiratory arrest, loss of consciousness, flaccid paralysis |
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What happens with a subfalcine herniation?
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-cingulate gyris herniates under the falx
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What are some clinical presentations of a sub arachnoid hemmorhage? What is the most common cause?
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-SUDDEN onset of severe headache
-may exhibit suddner alteration in consciousness -may occur after exertion -most common cause is a rupture of a sacular intracerebral aneurysm |
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How would one evaluate for a subarachnoid hemorrhage?
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-ABCs, H&P, CT to look for blood (if pos. prompt neuro evaluaiton), if negative you MUST do a lumbar puncture to look for bleeding, angiography to look for vascular abnormality
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What is an epidural hematoma? What dies it usually result from?
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-colleciton of blood situated between the skull and dura
-usually results from blunt head trauma which can result in a linear skull fracture (bleeding usually comes from a torn middle meningeal artery). Deterioration can occur quickly due to arterial bleeding. |
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What is a subdural hematoma? What is it most often due to?
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-collection of blood between the dura and the surface ofthe brain (note this is slower evolving than epidural hematoma)
-can occur bilaterally -due to the tearing of bridging veins between the cortex and dura |
