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2011-07-17 12:16:10
clin path

clin path 6
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  1. aneurysm
    • dilation due to weakness in wall of vessel
    • most are congenital "berry" aneurysms: defect in muscular layer of artery
    • 20-30% of cases there are multiple aneurysms
  2. complications of aneurysm
    • subarachnoid hemorrhage
    • complications after a bleed- rebleeding, cerebral ischemia, hydrocephalus
    • giant aneurysms present as space occupying lesion
  3. arteriovenous malformations
    abnormal vascular communication allowing aterial blood to enter venous system without passing through capillaries (at arterial pressure)
  4. presentation of AVM
    • headache
    • seizures
    • intra-cerebral "steal"- blood shunted to AVM
    • often no sx prior to rupture
  5. complications of AVM
    • subarachnoid hemorrhage
    • intracerebral hemorrhage
    • risk of rebleeding much lower than with aneuryms
  6. epidural hematoma
    • collection of blood, can cause arterial damage; bleeding between skull and dura
    • CT- convex margin against the brain
    • doesn't cross sutures
  7. presentation of epidural hematoma
    • focal mass effect
    • grows rapidly, may have rapid LOC
    • may have initial brief LOC (then better, then get foggy again) then inc headache and neurological symptoms
  8. subdural hematoma
    • bleeding into potential space between dura and arachnoid
    • CT- concave border against brain
    • can cross suture lines
  9. presentation of subdural hematoma
    • acute: develops over several hours following trauma; brief lucid period, then LOC
    • chronic: develops over days to weeks; drowsiness, slowing of cognition; unsteady gait; elderly who present with headache and dec mental/functional status should be evaulated for SDH
  10. subarachnoid hemorrhage
    • bleeding into space between pia and dura
    • trauma is most common cause
    • berry aneurysms responsible for 90%
  11. presentation subarachnoid hemorrhage
    • sudden severe headaches "worst ever"
    • transient LOC
    • vomiting
    • neck stiffness
    • may have convulsive seizures
  12. treatment SAH
    • adress underlying cause (anuerysm or AVM)
    • prevent secondary complications: rebleeding, vasospasm, hydrocephalus, hyponatremia, seizures
    • minimize cerebral ischemia if vasospasm results
  13. presentation brain tumors
    • increased ICP (can compress CN VI or edema of optic nerve)
    • lethargy
    • mental clouding
    • change in emotional state
    • seizures
    • focal neurological signs, slow onset
  14. challenges to PT for pts with cancer
    • side-effects of meds
    • fatigue
    • pain
    • anemia
  15. hematoma
    collection of blood, can cause arterial damage
  16. contusion
    (bruise), bleeding of only capillaries
  17. hemorrhage