Intracranial Bleeding Quiz

CBF is modulated by cerebral metabolic rate, cerebral perfusion pressure (CPP, the difference between MAP and ICP), and PaCO2 and PaO2 tensions.

The formula for calculating cerebral perfusion pressure (CPP) is $CPP = MAP - ICP$, where MAP is the mean arterial pressure and ICP is the intracranial pressure.

In an awake person, the normal cerebral blood flow (CBF) is 50 mL/100g brain tissue per min.

<p>The formula for calculating mean arterial pressure (MAP) is $MAP = (SBP + 2 imes DBP) / 3$, where SBP is the systolic blood pressure and DBP is the diastolic blood pressure.</p> Signup and view all the answers

<p>The autoregulatory range for maintaining blood flow in the brain is typically considered to be a MAP range of 50-150 mm Hg. However, recent data suggest that the lower limit of autoregulation may be greater than 50 mm Hg in normotensive individuals, and the range may be dynamic, changing in response to physiologic factors.</p> Signup and view all the answers

<p>Conservative medical management if the patient's condition stabilizes, but surgical evacuation of the clot is desirable in most patients.</p> Signup and view all the answers

<p>Most subdural hematomas are drained via burr holes, and the procedure can be performed during general anesthesia, local anesthesia, or monitored anesthesia care (MAC).</p> Signup and view all the answers

<p>If the subdural hematoma is large, chronic, or consists of clotted blood, the removal may require craniotomy.</p> Signup and view all the answers

<p>Normocapnia is desirable following evacuation of the hematoma to allow for a larger brain volume, which may help to tamponade any sites of venous bleeding, as a subdural hematoma is usually caused by venous bleeding.</p> Signup and view all the answers

<p>Following hematoma evacuation, it may be best to avoid significant head elevation if the patient is able to tolerate a more horizontal position. The horizontal position allows for a larger brain volume due to increased venous blood volume that can tamponade further bleeding.</p> Signup and view all the answers

<p>Conditions such as intracranial tumors, head trauma, and volatile anesthetics can impair autoregulation of cerebral blood flow (CBF).</p> Signup and view all the answers

<p>Signs and symptoms of increased ICP include headache, nausea, vomiting, papilledema, decreased LOC, and coma.</p> Signup and view all the answers

<p>Increased impairment of autoregulation leads to greater dependence of CBF on systemic blood pressure.</p> Signup and view all the answers

<p>Cushing's triad comprises HTN, bradycardia, and irregular respirations. Hyperglycemia exacerbates brain damage caused by lack of blood flow and oxygen.</p> Signup and view all the answers

<p>General anesthesia with volatile agents increases CBF and decreases cerebral metabolism, while nitrous oxide increases both CBF and cerebral metabolism.</p> Signup and view all the answers

<p>Variations in PaCO2 produce corresponding changes in CBF via vasodilation and vasoconstriction. An increase in PaCO2 causes vasodilation, leading to an increase in CBF, while a decrease in PaCO2 causes vasoconstriction, leading to a decrease in CBF.</p> Signup and view all the answers

<p>The brain maintains CBF at constant levels despite changes in CPP through autoregulation. Cerebral vessels are maximally constricted and CBF varies proportionally with CPP when CPP is increased above the upper limit of autoregulation. Cerebral ischemia may ensue if CPP is below the lower limit of autoregulation (~ 50 mm Hg).</p> Signup and view all the answers

<p>Decreased PaO2 does not significantly affect CBF until a threshold value of approximately 50 mmHg is reached.</p> Signup and view all the answers

<p>Cerebral blood volume (CBV) and cerebral blood flow (CBF) are influenced by vasodilatory anesthetics, hypercapnia, and systemic hypotension. Variations in PaCO2 produce corresponding changes in CBF via vasodilation and vasoconstriction.</p> Signup and view all the answers

<p>The ability of hypocapnia to acutely decrease CBF, CBV, and ICP is fundamental to the practice of clinical neuroanesthesia.</p> Signup and view all the answers

<p>SIH typically presents with abrupt-onset orthostatic headache, worsened symptoms later in the day, and may cause tinnitus and hearing deficits.</p> Signup and view all the answers

<p>Risk factors for aneurysm rupture leading to subarachnoid hemorrhage include aneurysm size, systemic hypertension, and certain lifestyle factors.</p> Signup and view all the answers

<p>Approximately 70% to 75% of intracranial tumors diagnosed in adults are located supratentorially.</p> Signup and view all the answers

<p>The four major types of intracranial hematomas are epidural hematoma, traumatic subarachnoid hematoma, subdural hematoma, and intraparenchymal hematoma.</p> Signup and view all the answers

<p>Intraparenchymal hemorrhage involves an abnormal collection of blood within the brain tissue, and its treatment can be challenging.</p> Signup and view all the answers

<p>The SCUBA technique involves stereotactic implantation of a small catheter for blood aspiration in the treatment of intraparenchymal hemorrhage.</p> Signup and view all the answers

<p>Prompt ventricular drainage is crucial to treat signs of hydrocephalus in intraventricular hemorrhage.</p> Signup and view all the answers

<p>Blood pressure management aims to balance cerebral perfusion and decrease the risk of rebleeding or hematoma expansion.</p> Signup and view all the answers

<p>Epidural hematoma results from arterial bleeding into the space between the skull and dura, and prompt drainage is essential to prevent complications.</p> Signup and view all the answers

<p>Subdural hematoma typically evolves gradually over several days, with headache and drowsiness being characteristic findings, and surgical evacuation is often required for a better outcome.</p> Signup and view all the answers

<p>$CPP = MAP - ICP$</p> Signup and view all the answers

<p>75 mL/100g brain tissue per min</p> Signup and view all the answers

<p>$MAP = \frac{SBP + 2 \times DBP}{3}$</p> Signup and view all the answers

<p>CVP (12 mm Hg)</p> Signup and view all the answers

<p>MAP 50-150 mm Hg</p> Signup and view all the answers

<p>Causes vasodilation</p> Signup and view all the answers

<p>Through autoregulation</p> Signup and view all the answers

<p>CBF decreases due to vasoconstriction</p> Signup and view all the answers

<p>50 mmHg</p> Signup and view all the answers

<p>Chronic hypertension</p> Signup and view all the answers

<p>To allow for a larger brain volume and tamponade any sites of venous bleeding</p> Signup and view all the answers

<p>If the subdural hematoma is large, chronic, or consists of clotted blood</p> Signup and view all the answers

<p>Horizontal position to allow for a large brain volume due to increased venous blood volume</p> Signup and view all the answers

<p>Through burr holes</p> Signup and view all the answers

<p>Surgical evacuation of the clot</p> Signup and view all the answers

<p>5-15 mmHg</p> Signup and view all the answers

<p>Coughing against a partially closed glottic opening</p> Signup and view all the answers

<p>Hypertension, bradycardia, irregular respirations</p> Signup and view all the answers

<p>Increases both CBF and cerebral metabolism</p> Signup and view all the answers

<p>Increases CBF and decreases cerebral metabolism</p> Signup and view all the answers

<p>Stereotactic implantation of a small catheter for blood aspiration</p> Signup and view all the answers

<p>Surgical evacuation</p> Signup and view all the answers

<p>Arterial bleeding into the space between the skull and dura; to avoid uncal herniation and brainstem compression</p> Signup and view all the answers

<p>Headache and drowsiness</p> Signup and view all the answers

<p>Decreases CBF, increases CBV, increases ICP</p> Signup and view all the answers

<p>Increasing age</p> Signup and view all the answers

<p>Rupture of intracranial aneurysms</p> Signup and view all the answers

<p>Clinical symptoms and CT demonstration of subarachnoid blood</p> Signup and view all the answers

<p>3 to 15 days after the event</p> Signup and view all the answers

<p>Acute hemorrhagic strokes</p> Signup and view all the answers