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Acute Hemorrhagic Stroke

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Acute Neuro Care

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Abstract

65-year-old right-handed, male, known case of hypertension since 10 years (irregular medication) is brought to EMS with chief complaints of:

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Author information

Authors and Affiliations

  1. Jaslok Hospital and research centre, Mumbai, India

    M. R. Rajani & Rajshree Deopujari

  2. P D Hinduja hospital and medical research centre, Mumbai, India

    Shwetal Goraksha & Joseph Monteiro

Authors
  1. M. R. Rajani
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  2. Rajshree Deopujari
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  3. Shwetal Goraksha
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  4. Joseph Monteiro
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Editor information

Editors and Affiliations

  1. Division of Neuroanaesthesiology, Department of Anaesthesiology and critical care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

    Prasanna Udupi Bidkar

  2. Senior consultant and Head, Neuroanaesthesiology & Neurocritical care, MGM Healthcare Pvt Ltd, Chennai, Tamil Nadu, India

    Ponniah Vanamoorthy

Multiple Choice Questions

Multiple Choice Questions

  1. 1.

    A patient presents to the emergency department with a severe headache and is suspected of having an intracerebral bleed. What is the next step in the investigation?

    1. (a)

      Brain MRI

    2. (b)

      CT of the brain with contrast

    3. (c)

      CT of the brain without contrast

    4. (d)

      Lumbar puncture

  2. 2.

    A 62-year-old lady with a history of atrial fibrillation on Warfarin, comes to ED with right-sided weakness. BP is 195/120 mmHg, irregular heart rate approximately 92 bpm and blood sugar of 325 mg/dL and INR >6. Emergent noncontrast CT brain revealed an intracerebral hemorrhage in the left internal capsule bordered by edema. All the following should be given to the patient except

    1. (a)

      Insulin

    2. (b)

      Fresh frozen plasma

    3. (c)

      IV labetalol

    4. (d)

      Phenytoin

    5. (e)

      IV Vitamin K

  3. 3.

    An elderly patient on warfarin with a cerebellar hemorrhage is in the intensive care unit. Appropriate reversal agents for his coagulopathy were previously administered and the patient’s last INR was 1.2 this morning. His mental status suddenly declines. Which of the following is true regarding the management of this patient when managing spontaneous intracranial hemorrhage (ICH)?

    1. (a)

      Osmotic agents may be used to decrease the amount of intracranial hemorrhage (ICH)

    2. (b)

      Consider emergent decompressive surgery

    3. (c)

      The hyperosmolar agent hypertonic saline is superior to mannitol in the treatment of increased intracranial pressure

    4. (d)

      Immediately administer 2 units of fresh frozen plasma and the appropriate weight-based dose of prothrombin complex concentrate

  4. 4.

    The commonest site of intracranial hypertensive bleed is

    1. (a)

      Cerebellum

    2. (b)

      Basal ganglia

    3. (c)

      Brainstem

    4. (d)

      Hippocampus

    5. (e)

      Cerebral hemispheres

  5. 5.

    Which of the following is recommended to treat coagulopathy in spontaneous intracerebral hemorrhage?

    1. (a)

      Fresh frozen plasma

    2. (b)

      Vitamin K

    3. (c)

      Prothrombin complex concentrate

    4. (d)

      rVIIIa

  6. 6.

    Decompressive surgery in intracerebral bleed is indicated in

    1. (a)

      All supratentorial bleeds

    2. (b)

      Infratentorial—when cerebellar bleed >3 cm

    3. (c)

      GCS >9

    4. (d)

      ICP <22 mmHg

  7. 7.

    Excluding trauma, which statement is true about intracranial hemorrhage?

    1. (a)

      55% of intracranial hemorrhage is intracerebral

    2. (b)

      Basal ganglia hemorrhage is most common

    3. (c)

      60% is due to amyloid angiopathy

    4. (d)

      Often asymptomatic

  8. 8.

    An 85-year-old male was brought to the emergency department with a right-sided facial droop and weakness of the right arm which occurred suddenly while watching the athletic event on television. He has a history of hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and benign prostatic hyperplasia. A workup revealed intracranial hemorrhage on the left. What percentage of strokes are hemorrhagic?

    1. (a)

      1–5%

    2. (b)

      20–30%

    3. (c)

      50%

    4. (d)

      80%

  9. 9.

    A 91-year-old female becomes acutely unresponsive in her assisted living care facility. She is taken to the hospital for a stroke workup and found to have a right frontal intraparenchymal hemorrhage with intraventricular extension. The estimated blood volume of the hemorrhage is 65 mL. She takes warfarin for non-valvular atrial fibrillation and has an INR of 2.1. She has hypertension, diabetes mellitus, asthma, gastroesophageal reflux disease, and stress incontinence. On initial exam, her eyes do not open to painful stimuli, she moans and withdrawals to noxious stimuli in the right arm and has extensor posturing in the left arm with extension of bilateral legs. What is her 30-day mortality based on the intracerebral hemorrhage score?

    1. (a)

      26%

    2. (b)

      72%

    3. (c)

      97%

    4. (d)

      100%

  10. 10.

    Current guidelines for ICP monitoring in ICH include all except:

    1. (a)

      Patients with GCS >8.

    2. (b)

      Hydrocephalus.

    3. (c)

      Patients with significant IVH.

    4. (d)

      Clinical evidence of transtentorial herniation.

Answers: 1. (c), 2. (d), 3. (b), 4. (b), 5. (c), 6. (b), 7. (b), 8. (b), 9. (c), 10. (a).

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Rajani, M.R., Deopujari, R., Goraksha, S., Monteiro, J. (2020). Acute Hemorrhagic Stroke. In: Bidkar, P., Vanamoorthy, P. (eds) Acute Neuro Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-4071-4_10

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