Harrison's Medicine Chapter 428 Quiz

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Questions and Answers

What is the primary imaging method used to diagnose intracranial hemorrhage in acute stroke evaluation?

Ultrasound

MRI

CT scan (correct)

X-ray

Which type of hemorrhage occurs directly within the brain parenchyma?

Epidural hemorrhage

Subdural hemorrhage

Subarachnoid hemorrhage

Intracerebral hemorrhage (correct)

What is often a distinguishing feature of patients presenting with intracranial hemorrhage compared to ischemic stroke?

Rapid alteration of consciousness

Presence of nausea

Evident headache (correct)

Accompanying seizures

Which vascular pathology is mentioned as a cause of intracranial hemorrhage?

Arteriovenous malformations (AVMs) Signup and view all the answers

What is the typical reason for the occurrence of subarachnoid hemorrhage?

Trauma or rupture of an aneurysm Signup and view all the answers

What significant aspect of CT imaging supports its use in diagnosing intracranial hemorrhage?

It has a high sensitivity and specificity for identifying hemorrhage. Signup and view all the answers

What condition is characterized by bleeding into the subdural and epidural spaces?

Trauma-induced hemorrhage Signup and view all the answers

Which imaging modality is generally considered more logistically challenging to perform than CT for acute stroke evaluation?

MRI Signup and view all the answers

Which type of intracranial hemorrhage is associated with ongoing hematoma expansion due to coagulopathy?

Coagulopathy Signup and view all the answers

What is the most common location for hemorrhage due to hypertensive events?

Basal ganglion Signup and view all the answers

Which cause of intracranial hemorrhage is linked to prior ischemic infarction?

Transformation of prior ischemic infarction Signup and view all the answers

What type of hemorrhage is primarily caused by arteriovenous malformation?

Subarachnoid Signup and view all the answers

Which intracranial hemorrhage cause is characterized by degeneration of intracranial vessels and is associated with dementia?

Amyloid angiopathy Signup and view all the answers

What is a common scenario leading to extra-axial hemorrhage?

Head trauma Signup and view all the answers

Which brain tumor type is known to potentially cause lobar hemorrhage?

Metastatic brain tumor Signup and view all the answers

Which form of aneurysm might rarely result in subdural hemorrhage?

Nonmycotic aneurysm Signup and view all the answers

Study Notes

Introduction to Intracranial Hemorrhage

Intracranial hemorrhage is a type of stroke, distinguished from ischemic stroke primarily by symptoms.
Patients with intracranial hemorrhage frequently present with headaches.
Brain imaging, particularly CT scans, is crucial for differentiating between intracranial hemorrhage and ischemic stroke.
CT imaging is preferred for its high sensitivity and specificity in assessing intracranial bleeding.

Classification of Intracranial Hemorrhage

Hemorrhages are categorized by location and vascular pathology, including:
- Intracerebral hemorrhage (ICH): Bleeding directly into brain tissue.
- Arteriovenous malformations (AVMs): Abnormal connections between arteries and veins in the brain.
- Other types include subdural, epidural, and subarachnoid hemorrhages, often linked to trauma or ruptured aneurysms.

Diagnosis of Intracranial Hemorrhage

Noncontrast CT is commonly used for acute stroke evaluation and can quickly identify intracranial hemorrhage.
CT is more readily available and logistically simpler than MRI, making it the preferred diagnostic tool in emergencies.
Different hemorrhage locations limit the differential diagnosis to a few potential causes.

Causes and Locations of Intracranial Hemorrhage

Head Trauma
- Locations: Intraparenchymal (frontal and anterior temporal lobes), subarachnoid, and extra-axial spaces (subdural, epidural).
- Mechanisms: Coup and contrecoup injuries due to brain deceleration.
Hypertensive Hemorrhage
- Affected Areas: Putamen, globus pallidus, thalamus, cerebellar hemisphere, pons.
- Pathophysiology: Chronic hypertension causes bleeding from small blood vessels (~30–100 μm) in these regions.
Transformation of Prior Ischemic Infarction
- Areas: Basal ganglia, subcortical regions, lobar regions.
- Occurrence: Found in 1–6% of ischemic stroke cases, often impacting large hemispheric infarctions.
Metastatic Brain Tumor
- Locations: Lobarly affected.
- Associated Cancers: Includes lung, choriocarcinoma, melanoma, renal cell carcinoma, thyroid cancer, and atrial myxoma.
Coagulopathy
- Impact: Can occur anywhere within the CNS.
- Implication: Increases the risk of ongoing hematoma expansion.
Drug Use
- Location: Can affect any area, including lobar and subarachnoid spaces.
- Common Drugs: Cocaine and amphetamines.
Arteriovenous Malformation
- Affected Areas: Lobar, intraventricular, and subarachnoid regions.
- Risk of Bleeding: Approximately 2–3% per year if the AVM is previously unruptured.
Aneurysm
- Locations: Subarachnoid, intraparenchymal, and occasionally subdural.
- Types: Can be mycotic or nonmycotic in nature.
Amyloid Angiopathy
- Location: Lobarly affected.
- Association: Linked to degenerative diseases of intracranial vessels; more common in patients with dementia.

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Description

Test your knowledge on intracranial hemorrhage as covered in Chapter 428 of Harrison's Principles of Internal Medicine. This quiz explores the presentation, diagnosis, and management of this critical condition. Ideal for medical students and professionals seeking to deepen their understanding of strokes.