Intracerebral Hemorrhage

Front 1

ICH cause and risk

Back 1

HTN --> medial lipohyalinosis, microaneurysm, microdissections.
CAA --> amyloid depositions, vessel inflammation, microaneurysm, microhemorrhages

risk factors: increased age, maleness, HTN, binge EtOH, hemorrhagic diathesis, vascular malformations, antithrombotic meds, sympathomimetic drugs, reperfusion syndrome, aneurysm, abscess, tumor

Front 2

ICH sxs

Back 2

occurs during exertion
head pain, N/V, altered consciousness
focal deficits (100%) depending on location
increased systemic BP, seizures, deep hemorrhage

comps: hydrocephalus --> increased ICP

Front 3

ICH treatment

Back 3

manage severe HTN (sys < 120 then < 100)
hyperosmolar tx (mannitol, hypothermia, sedation) to decrease edema
coagulation facotrs control hematoma expansion but no better outcome
surgery: hemicrniectomy, craniectomy with drainage, sterotactic craniotomy, suboccipital crniectomy for posterior fossa

Front 4

ICH dx modality

Back 4

cerebral CT

Front 5

SAH cause and risk

Back 5

berry aneurysms (hypoplasic vessel without muscularis or internal lamina at the bifurcation) (80%), AV malformations

risk: age, femalehood, HTN, tobacco

Front 6

SAH sxs

Back 6

mental status change, focal deficits, WHOL, N/V, nuchal rigidity, CN palsies (esp CN VI), seizures, coma, decerebrate

comps: vasospasm --> delayed cerebral ischemia, rehemorrhage, cardiac arrythmias, increased troponin, cardiogenic myopathy (takotsubo), hydrocephalus, seizures

Front 7

SAH dx modality

Back 7

cerbral CT catches 95% on day 1 but 50% on second day

missed in 25%

LP at least 6 hours after symptoms to find blood or xanthochromia (connected to subarachnoid space)

angiography is gold standard for detecting aneurysms

also look for IVH

transcranial doppler for vasospasm (look for increased blood velocity)

Front 8

SAH treatment

Back 8

surgical clipping/coiling of aneurysm
decrease pressure (nicardipine, labetolol)
cardiac: may need inotropes
salt tablets, seizure meds PRN

vasospasm: hypervolemia, hypertension, hemodilution. nimodipine (CCB) can improve outcome, though no knows effect on vasospasm. angioplasty and intra-arterial nicardiepine (CCB) if severe

Front 9

SDH cause and risk

Back 9

head trauma: MVA, falls, assaults --> torn bridging veins
arterial rupture (minority)
low CSF (eg after LP) --> traction on bridging veins --> rupture

risk: cerebral atrophy (aging, chronic EtOH, previous head trauma), coagulopahty, intracranial hoTN, vascular anomalies

Front 10

SDH sxs

Back 10

acute: coma (50%) (lucid interval followed by deterioration). post fossa: like increased ICP (headaches, anisocoria, dysphagia, vomiting) with CN palsies, nuchal rigidity.

chronic: insidious headache, light-headedness, cognitive decline, apathy, somnolence, maybe seizures. usually more global than focal.

Front 11

SDH dx modalities

Back 11

head CT: high-density crescentic collection if acute, isodense/hypodense crescent-shaped deformation if chronic.

MRI is more sensitive

Front 12

SDH mgmt

Back 12

surgical if SDH is more than 10 mm thick or midline shifts > 5 mm.

if chrnoic, also surgical for moderate/severe cognitive impairment

Front 13

EDH cause and risk

Back 13

head trauma, especially with lateral skull fracture. usually due to torn middle-meningeal artery

risk: teenage boys (probably)

Front 14

EDH sxs

Back 14

spectrum: coma, momentary loss of consciousness. have a lucid interval and then deterioration.

Front 15

EDH dx modalities

Back 15

head CT: 8% not apparent due to severe anemia, severe hoTN, slow venous bleeding

Front 16

EDH mgmt

Back 16

surgical for acute, symptomatic EDH to prevent hematoma expansion

non-operable managment is possible if small