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Old 09-15-2011
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Neuro Confused about cerebral hemorrhages and infarcts!

I have a big time confusion about the different types of cerebral hemorrhages...
1) what is the difference between LACUNAR INFARCT and CEREBRAL HEMORRHAGE?both have the same risk factors n similar presentations..
2) what is the difference between SUBARACHNOID and INTRACEREBRAL HEMORRHAGE?

Can anyone provide me with key points of different types of strokes? bleeding n infarcts...
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Old 09-15-2011
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Cool

- Lacunar stroke involves microatheroma formation and lipohyalinosis in the deep penetrating arteries supplying deep brain structures such as posterior internal capsule, pons, thalamus, etc.
- Due to blockage by microatheromas , hypoperfusion or ischemia occurs
-There can be different presentations of lacunar stroke depending on structure involved but the most commonly involved is posterior internal capsule which gives pure motor stroke/hemiperesis
-Others can be,
Ataxic hemiperesis, pure sensory stroke, mixed stroke,etc
-Do CT scan without contrast to exclude intracerebral hemorrhage
-Intracerebral hemorrhage gives signs of hemorrhage on CT
-Lacunar stroke don t give signs of hemorrhage

i hope u get it , thanks.
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Old 09-15-2011
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Default lacuna

1. CNS infarcts are either due to ischemia (80% of cases) or hemorrhage (20%)
2. Size may vary from huge infarcts involving certain arterial basin or small ones. Lacunar infarcts are small. Big usually involve sensori-motor neurons. Small involve either sensory or motor.
3. SAH leads to increase in ICP usually w/o focal signs-it may look, clinically, like meningo.

Clinical Dx simplified
So if you see a patient with focal signs-suspect stroke
No focal signs + signs of ICP up+ no fever +/- meningism-suspect SAH
No focal signs +/- signs of ICP up+ fever/ rash+ meningism-suspect meningo

Instrumental+ Lab Dx simplified
If you suspect stroke-do CT first
If you suspect SAH-do CT first-next LP
If you suspect meningo and NO signs of ICP up-do LP C&S-> give AB before results available
If you suspect meningo and YES signs of ICP up->take blood culture+ give AB - > DO CT before LP!!! LP if no risk of herniation

Rx
-ischemic stroke-give tPA w/3hrs+/- ASA
-hemor.-do nothing, sometimes some people may give ASA
-SAH-if trauma-do angio find the vessel-ligate, if no trauma-may be expectant managment
-Meningo-see above+ start with vanco+genta+ ampi (ampi if neonate or >55-60y.o to cover Listeria)-> then according to C&S
-If HSV meningo suspected-give acyclo

Last edited by musand; 09-15-2011 at 09:20 PM.
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Old 09-15-2011
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Even SAH may have signs of menigsmus due to cervical nerve irritation and fever, the most imp. is the sever ,sudden headache ,that is very typical of it, rest of the things u have well explained.
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Old 09-15-2011
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Quote:
Originally Posted by iron View Post
Even SAH may have signs of menigsmus due to cervical nerve irritation and fever, the most imp. is the sever ,sudden headache ,that is very typical of it, rest of the things u have well explained.
yep I meant signs of ICP up that included meningismus , then made a correction separating meningismus from other more worrisome signs like papiledema, consc. down etc
yep SAh-"the most severe of my life" agreed, but you rarely see this description on the real test

Last edited by musand; 09-15-2011 at 09:27 PM.
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Old 09-16-2011
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Quote:
Originally Posted by musand View Post
yep I meant signs of ICP up that included meningismus , then made a correction separating meningismus from other more worrisome signs like papiledema, consc. down etc
yep SAh-"the most severe of my life" agreed, but you rarely see this description on the real test
yes ,they may not be giving the classical description, in SAH ,generally there is no focal neurological deficits. It is mainly due to sacular aneureusym, least possible is trauma. They may point twds other clues like xanthochromia in LP analysis.
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