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Questions and Answers
What is a possible cause of spontaneous intracranial hemorrhage?
What is a possible cause of spontaneous intracranial hemorrhage?
What is the appropriate imaging modality to diagnose intracranial hemorrhage?
What is the appropriate imaging modality to diagnose intracranial hemorrhage?
What is the purpose of laboratory work up in intracranial hemorrhage?
What is the purpose of laboratory work up in intracranial hemorrhage?
What is a characteristic of CSF in subarachnoid hemorrhage?
What is a characteristic of CSF in subarachnoid hemorrhage?
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What is a symptom that requires symptomatic treatment in intracranial hemorrhage?
What is a symptom that requires symptomatic treatment in intracranial hemorrhage?
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What is a potential complication of intracranial hemorrhage?
What is a potential complication of intracranial hemorrhage?
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What is a possible cause of Terson Syndrome?
What is a possible cause of Terson Syndrome?
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What is the treatment for cerebral edema in intracranial hemorrhage?
What is the treatment for cerebral edema in intracranial hemorrhage?
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What is a possible cause of cranial nerve palsy in intracranial hemorrhage?
What is a possible cause of cranial nerve palsy in intracranial hemorrhage?
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What is the purpose of nursing the patient in a quiet, dark room?
What is the purpose of nursing the patient in a quiet, dark room?
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Study Notes
Cerebrovascular Stroke
- Stroke: a rapidly developing clinical symptoms and/or signs of focal or global loss of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.
Transient Ischemic Attacks (TIA)
- TIA: transient focal neurological deficits lasting for less than 24 hours, usually minutes, of vascular ischemic origin with complete recovery.
- Definition is no longer time-based but tissue-based.
- Increased risk of stroke following TIA, especially in the acute phase.
- A quarter of stroke patients experience a TIA preceding the stroke.
Worldwide and Egypt Stroke Burden
- Annually, 15 million people worldwide suffer a stroke, with 5 million dying and another 5 million left permanently disabled.
- In the United States, acute ischemic stroke affects approximately 800,000 people annually, translating to one person having a stroke every 40 seconds.
- In Egypt, the number of new strokes per year may be around 150,000 to 210,000.
Stroke Mortality
- Stroke accounts for 6.4% of all deaths, ranking 3rd after heart disease and gastrointestinal diseases, followed closely by cancer (6.1%).
- WHO estimates that 85% of stroke deaths occur in low and middle-income countries, with disability-adjusted life years lost to stroke being almost seven times that in high-income countries.
Risk Factors for Stroke
- Obesity (mainly truncal obesity) and high body mass index (BMI) increase the risk of stroke.
- Physical inactivity and chronic stress are also risk factors.
Causes of Ischemic Stroke (TOAST Classification)
- Arterial wall diseases (TOAST 1): 50% of causes, including atherothromboembolism.
- Intracranial small vessel diseases (TOAST 3): 25% of causes, including Binswanger's disease and multiple risk factors.
- Embolism from the heart (TOAST 2): 20% of causes, including paradoxical embolism, atrial septal defect, ventricular septal defect, and patent foramen ovale.
- Other causes: inflammatory vascular diseases, irradiation, trauma leading to dissection, hematological disorders, and hypercoagulability.
Clinical Presentation and Localization
- The site of the lesions in the nervous system has two concerns: etiology of hemiplegia and blood electrolytes leading to electrolyte imbalance.
Treatment of Acute Ischemic Stroke
- General measures: maintenance of vital signs, cardiovascular support, and nursing care.
- Specific treatment: Time window and revascularization therapy, including thrombolytic agents (t-PA and tenecteplase) and mechanical thrombectomy.
Rehabilitation and Secondary Prevention
- Rehabilitation by a physiotherapist after the first few days.
- Secondary prevention: tight control of all risk factors, aspirin for life, clopidogrel for the first three weeks, oral anticoagulant, and treatment of carotid stenosis and intracranial stenosis.
Cerebral Hemorrhage
- Types: extradural hematoma, subdural hematoma, intracerebral hematoma, and subarachnoid hemorrhage.
Subarachnoid Hemorrhage
- Clinical presentation: sudden onset, severe headache, nausea, vomiting, fever, and vertigo.
- Signs and symptoms of meningeal irritation, including stiff neck, painful back, and painful restricted straight leg raising sign.
- Causes: hypertension, amyloid angiopathy, vascular malformation, aneurysms, and hemorrhagic blood diseases.
Investigations in Hemorrhage
- Imaging: CT-brain, MRI brain, CT angiography, and digital subtraction angiography.
- Laboratory workup: complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PT), international normalized ratio (INR), protein C, protein S, and antithrombin 3.
- Lumbar puncture: to diagnose subarachnoid hemorrhage, with findings including bloody cerebrospinal fluid (CSF) under tension, high protein content, and xanthochromia.
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Description
This quiz covers the causes and effects of intracerebral hemorrhage, including hypertension, vascular malformations, and blood diseases. It also discusses the effects on cranial nerves and local pressure.
