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30 Cards in this Set
- Front
- Back
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Hemorrhagic Stroke:
Accounts for about 20% of acute strokes Common causes: ... bleeding due to -Hypertension -Amyloid angiopathy ... hemorrhage -Aneurysm or other vascular abnormality -Trauma Other structural abnormality (tumors) |
Intracerebral
Subarachnoid |
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Intracerebral hemorrhage (spontaneous hemorrhage):
Small penetrating arteries are damaged by prolonged ... These bleeds most always arise in what 4 locations (starting with the most common) ? |
hypertension
Putamen, Thalamus, Pons, Cerebellum |
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... hemorrhage (Presentation is very similar to occlusion of the middle cerebral artery)
Contralateral hemiplegia and hemianesthesia Homonymous hemianopsia Gaze preference (toward the side of the lesion) Aphasia (if on the dominant side) hemineglect (if on the non-dominant side) Alteration in consciousness (rapid) |
Putaminal
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... Hemorrhage:
Clinical presentation: -Contralateral hemiparesis and hemianesthesia -Sensory loss may be disproportionately greater than the motor deficit -Eyes may deviate away from the lesion (“wrong-way eyes”) -Often have restriction of upward gaze (forced downward deviation) -May have significant alteration of consciousness (rapid) |
Thalamic
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... Hemorrhage:
Clinical presentation -Early coma -Pinpoint pupils that react to light -Impaired or absent response to caloric testing -Decerebrate posturing (extensor posturing) |
Pontine
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... Hemorrhage:
Clinical presentation: Sudden onset of “dizziness” and vomiting Truncal ataxia with difficulty walking Usually no significant alteration of consciousness early -May progress to coma or death as edema worsens May show signs of ipsilateral pontine compression -Gaze preference to side of the lesion, ipsilateral facial weakness, diminished corneal reflex on the affected side |
Cerebellar
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...:
Common cause of intracerebral hemorrhage in the elderly These bleeds tend to be lobar -May be recurrent or multiple |
Amyloid angiopathy
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Intracerebral hemorrhage Management:
ABCs Increased intracranial pressure -May need to treat edema -... the head of the bed to at least 30-45 degrees -... can be used temporarily May require surgical evacuation |
Elevate
Hyperventilation |
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Deterioration of patients with stroke is often due to increasing intracranial pressure due to ...
Cerebral perfusion pressure = mean arterial blood pressure- intracranial pressure Worsening ischemia may occur if cerebral perfusion ... |
cerebral edema
falls |
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Cerebral edema:
Cushing’s Triad of increased intracranial pressure: -... -... -... Only about 33% of individuals with increased pressure exhibit the full triad |
Hypertension
Bradycardia Respiratory irregularities |
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Cerebral edema:
Vasogenic edema: Affects ... matter -Usually associated with neoplasms, stroke, infection -Edema associated with ... usually responds to corticosteroids |
white
neoplasms |
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Cerebral edema:
Cytotoxic edema: Affects ... matter -Usually associated with ... |
gray
trauma |
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Treatment of cerebral edema:
Vasogenic edema may respond to ... ... agents -Mannitol: 0.5 to 1.5 g/Kg -Glycerol: 1 g/Kg -Loop diuretics (furosemide) |
corticosteroids
Osmotic |
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... - Most often results from a laterally placed mass displacing the brain stem contralaterally and pushing the uncus of the temporal lobe medially over the tentorial edge.
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uncal herniation
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Uncal herniation:
Early Sign: -... Late Signs: -Complete ... -Loss of ... -Contralateral hemiplegia (secondary to mass) -Ipsilateral hemiplegia (secondary to compression of contralateral cerebral peduncle against edge of tentorium [Kernohan’s notch]) -Flaccid paralysis |
Ipsilateral pupillary dilation
ipsilateral third nerve palsy consciousness |
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Tonsillar herniation:
Results from downward displacement of the cerebellar tonsils through the ..., causing compression of the cervicomedullary junction. Frequently secondary to posterior fossa mass. May be precipitated by ... in the presence of such a mass. Signs: -Neck pain -Respiratory arrest -Loss of consciousness -Flaccid paralysis |
foramen magnum
lumbar puncture |
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... herniation:
The cingulate gyrus herniates under the falx -May be asymptomatic unless the anterior cerebral artery is compressed |
subfalcine
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...:
Clinical presentation Sudden onset of severe headache -“the worst headache ever experienced” May exhibit sudden alteration in consciousness -May have completely normal exam May occur after exertion |
subarachnoid hemorrhage
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Subarachnoid hemorrhage:
-The most common cause is rupture of a ... -Majority of patients are between the ages of 35 and 65 -Can be associated with other vascular abnormalities such as arteriovenous malformation -Can occur after ... |
saccular intracerebral aneurysm
trauma |
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look at slides 32 and 33
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ok
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Subarachnoid hemorrhage:
Evaluation: History and physical ABCs ... brain to look for blood -If positive, a prompt neurological/neurosurgical evaluation -If negative, MUST do a ... to look for bleeding (10% of patients with definite subarachnoid hemorrhage will a negative CT) Angiography to look for vascular abnormality |
CT
lumbar puncture |
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Subarachnoid Hemorrhage:
Treatment Supportive care -Maintain normal ... -Continuous monitoring -... management nimodipine (Nimotop) 60 mg every 4 hours to reduce vasospasm Neurosurgical intervention, if indicated |
blood volume
Pain |
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...:
A collection of blood situated between the skull and the dura Usually results from blunt head trauma which may result in a linear skull fracture -Bleeding typically comes from a torn middle meningeal artery Deterioration can occur quickly due to arterial bleeding Treatment is surgical |
Epidural Hematoma
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...:
A collection of blood between the dura and the surface of the brain -...: up to 24 hours old -...: 1 to 10 days old -...: more than 10 days old Can occur bilaterally Most often due to tearing of bridging veins between the cortex and the dura Treatment depends on the severity of neurological deficits -Surgical intervention may be necessary |
Subdural Hematoma
Acute Subacute Chronic |
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...:
A lesion affecting the middle cerebral peduncle may damage pyramidal fibers and the fascicle of cranial nerve III Clinical findings -Contralateral hemiplegia (including the lower face) -Ipsilateral oculomotor paresis, including parasympathetic dysfunction (dilated pupil) |
Weber Syndrome
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Results from a lesion affecting the mesencephalic tegmentum, red nucleus, brachium conjunctivum, and fascicle of CN III Clinical findings -Ipsilateral oculomotor paresis (dilated pupil) -Contralateral involuntary movements |
Benedikt Syndrome
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A lesion of the ventrocaudal pons may involve the basis pontis and fascicles of cranial nerves VI and VII Clinical findings -Contralateral hemiparesis (sparing the face) -Ipsilateral rectus paresis -Ipsilateral facial paresis |
Millard-Gubler Syndrome
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...:
Due to a rostral lesion of the dorsal pons Clinical features -Cerebellar ataxia due to involvement of the cerebellum -Contralateral reduction of all sensory modalities (face and extremities) due to involvement of the medial lemniscus and spinothalamic tract -May also see contralateral hemiparesis if lesion extends more ventrally |
Raymond-Cestan Syndrome
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...:
Clinical features -Ipsilateral facial hypalgesia or may have ipsilateral facial pain -Contralateral trunk and extremity hypalgesia and thermoanesthesia -Ipsilateral palatal, pharyngeal, and vocal cord paralysis -Ipsilateral Horner syndrome (interrupts descending sympathetic fibers) -Vertigo, nausea, and vomiting -Ipsilateral cerebellar signs Lesion in the medulla and inferior cerebellum -Usually due to infarct in the territory of the posterior inferior cerebellar artery or vertebral artery occlusion |
Wallenberg Syndrome (lateral medullary syndrome)
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...:
Due to bilateral ventral pontine lesions Clinical findings -Quadriplegia -Aphonia -The patient remains awake (no involvement of the reticular formation) and may be able to communicate by blinking |
Locked-In Syndrome
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