Neuroimaging and Intracranial Hemorrhage

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30 Questions

If SAH is suspected but non con CT is normal What is required? VSWhat is required for DEFINITIVE DIAGNOSIS?

REQUIRED= LP definitive diagnosis- catheter based angiography

What intervention is recommended for subarachnoid hemorrhage patients with the presence of hydrocephalus on neuroimaging?

Neurosurgical placement of an external ventricular drain

What is the most common cause of intracerebral hemorrhage that affects deep structures of the brain, and what is the mainstay of prevention for this condition?

Hypertension; control of blood pressure

What is the only thrombolytic agent approved for use in acute ischemic stroke?

Recombinant tissue plasminogen activator (alteplase)

When is alteplase most effective when administered in acute ischemic stroke?

Within 3 hours of ischemic stroke onset with disabling symptoms

What is the significant outcome associated with early administration of alteplase in acute ischemic stroke?

Reduction in disability at 3 months

What is the role of MRI in selecting patients for IV alteplase administration in acute ischemic stroke?

Identifying diffusion-positive FLAIR-negative lesions

In patients with acute ischemic stroke, what is the significance of unclear time of onset?

It can lead to consideration of MRI to identify eligible patients for IV alteplase administration

What is the time window for IV alteplase administration in patients with acute ischemic stroke who awake with stroke symptoms?

Within 4.5 hours of stroke symptom recognition

What are the main risk factors for symptomatic hemorrhage in stroke patients?

Treatment after 4.5 hours and hypertension before and after treatment

What are the key considerations for IV alteplase administration in acute ischemic stroke?

Time window for administration and unclear time of onset

What is the significance of catheter-based angiography in the diagnosis of aneurysms and subarachnoid hemorrhage?

Main purpose of diagnosis and intervention planning

What should be the maximum blood pressure reading before treatment with alteplase in patients with acute ischemic stroke?

Less than 185/110 mm Hg

Why should nitrates be avoided in patients with acute ischemic stroke before treatment with alteplase?

Due to their potential to increase intracranial pressure

What are the main risk factors for symptomatic hemorrhage in stroke patients?

Treatment after 4.5 hours and hypertension before and after treatment

What specific examination and radiologic findings are required for recommending endovascular therapy within 24 hours of stroke onset?

measurable neurologic deficit and small but radiographically evident ischemic changes

What noninvasive vessel imaging techniques are recommended for patients considered for endovascular therapy?

CTA or MRA

What is the recommended primary method for endovascular therapy within 24 hours of stroke onset?

intra-arterial mechanical thrombectomy

In a recent trial, what medications were compared within 24 hours of stroke onset, and what was the outcome?

Aspirin and ticagrelor; no difference in the risk of recurrent stroke during 90 days of treatment was noted

What is the NIHSS score range for the patient population that has been the focus of recent trials of antiplatelet therapy?

5 or less

What is the recommended systolic blood pressure target for acute treatment of patients with intracerebral hemorrhage?

140 mm Hg

Why should IV nitrates and nitroprusside be avoided in patients with intracerebral hemorrhage?

They may raise intracranial pressure and reduce blood flow to the ischemic region.

What is the primary predictor of early hematoma expansion in acute intracerebral hemorrhage?

Elevated blood pressure

What is the systolic blood pressure threshold for initiating treatment in patients with intracerebral hemorrhage?

Greater than 150 mm Hg

What is the preferred intervention over medical therapy when elevated intracranial pressure and hydrocephalus result in decreased level of consciousness in intracerebral hemorrhage?

Ventricular drainage

What type of therapy is ineffective in reducing cerebral edema in intracerebral hemorrhage and should not be routinely administered?

Glucocorticoids

Which two substances may temporarily reduce intracranial pressure in intracerebral hemorrhage when used as short-term bolus osmotherapy?

Mannitol or hypertonic saline

What is the purpose of catheter-based angiography in the diagnosis of aneurysms and subarachnoid hemorrhage?

To diagnose and potentially treat a cerebral aneurysm

In patients with symptoms suggestive of SAH and normal noncontrast head CT findings, what procedure is required to evaluate for the presence of blood or xanthochromia?

Lumbar puncture

What should be done if SAH is confirmed in a patient?

Catheter-based angiography

Study Notes

Subarachnoid Hemorrhage (SAH)

  • If SAH is suspected but non-contrast CT is normal, a lumbar puncture is required to evaluate for the presence of blood or xanthochromia.
  • For definitive diagnosis of SAH, LP or CT angiography is required.

Hydrocephalus and SAH

  • In SAH patients with hydrocephalus on neuroimaging, ventriculostomy is recommended.

Intraparenchymal Hemorrhage

  • Hypertension is the most common cause of intracerebral hemorrhage that affects deep structures of the brain.
  • Blood pressure control is the mainstay of prevention for this condition.

Alteplase in Acute Ischemic Stroke

  • The only thrombolytic agent approved for use in acute ischemic stroke is alteplase.
  • Alteplase is most effective when administered within 3-4.5 hours of acute ischemic stroke.
  • Early administration of alteplase is associated with improved outcomes, including independence and reduced mortality.
  • MRI is used to select patients for IV alteplase administration in acute ischemic stroke.

Patient Selection for Alteplase Administration

  • Patients with unclear time of onset of stroke are not eligible for alteplase administration.
  • The time window for IV alteplase administration in patients with acute ischemic stroke who awake with stroke symptoms is within 4.5 hours of waking.
  • Key considerations for IV alteplase administration include time of onset, patient age, and stroke severity.

Catheter-Based Angiography

  • Catheter-based angiography is significant in the diagnosis of aneurysms and subarachnoid hemorrhage.

Blood Pressure Management

  • The maximum blood pressure reading before treatment with alteplase in patients with acute ischemic stroke is 185/110 mmHg.
  • Nitrates should be avoided in patients with acute ischemic stroke before treatment with alteplase due to risk of hypotension.

Endovascular Therapy

  • Specific examination and radiologic findings, including large vessel occlusion, are required to recommend endovascular therapy within 24 hours of stroke onset.
  • Noninvasive vessel imaging techniques, including CTA or MRA, are recommended for patients considered for endovascular therapy.
  • The recommended primary method for endovascular therapy within 24 hours of stroke onset is mechanical thrombectomy.

Intracerebral Hemorrhage

  • The recommended systolic blood pressure target for acute treatment of patients with intracerebral hemorrhage is 140 mmHg.
  • IV nitrates and nitroprusside should be avoided in patients with intracerebral hemorrhage due to increased risk of increased intracranial pressure.
  • The primary predictor of early hematoma expansion in acute intracerebral hemorrhage is Spot Sign on CT angiography.
  • The systolic blood pressure threshold for initiating treatment in patients with intracerebral hemorrhage is 150 mmHg.
  • Ventriculostomy is preferred over medical therapy when elevated intracranial pressure and hydrocephalus result in decreased level of consciousness in intracerebral hemorrhage.
  • Corticosteroids are ineffective in reducing cerebral edema in intracerebral hemorrhage and should not be routinely administered.
  • Mannitol and hypertonic saline may temporarily reduce intracranial pressure in intracerebral hemorrhage when used as short-term bolus osmotherapy.

This quiz covers the diagnostic procedures and management of intracranial hemorrhage, including the use of catheter-based angiography, neurosurgical placement of external ventricular drain, and the common causes of intracerebral hemorrhage affecting deep brain structures.

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