-
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
-
complications of aneurysm
- subarachnoid hemorrhage
- complications after a bleed- rebleeding, cerebral ischemia, hydrocephalus
- giant aneurysms present as space occupying lesion
-
arteriovenous malformations
abnormal vascular communication allowing aterial blood to enter venous system without passing through capillaries (at arterial pressure)
-
presentation of AVM
- headache
- seizures
- intra-cerebral "steal"- blood shunted to AVM
- often no sx prior to rupture
-
complications of AVM
- subarachnoid hemorrhage
- intracerebral hemorrhage
- risk of rebleeding much lower than with aneuryms
-
epidural hematoma
- collection of blood, can cause arterial damage; bleeding between skull and dura
- CT- convex margin against the brain
- doesn't cross sutures
-
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
-
subdural hematoma
- bleeding into potential space between dura and arachnoid
- CT- concave border against brain
- can cross suture lines
-
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
-
subarachnoid hemorrhage
- bleeding into space between pia and dura
- trauma is most common cause
- berry aneurysms responsible for 90%
-
presentation subarachnoid hemorrhage
- sudden severe headaches "worst ever"
- transient LOC
- vomiting
- neck stiffness
- may have convulsive seizures
-
treatment SAH
- adress underlying cause (anuerysm or AVM)
- prevent secondary complications: rebleeding, vasospasm, hydrocephalus, hyponatremia, seizures
- minimize cerebral ischemia if vasospasm results
-
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
-
challenges to PT for pts with cancer
- side-effects of meds
- fatigue
- pain
- anemia
-
hematoma
collection of blood, can cause arterial damage
-
contusion
(bruise), bleeding of only capillaries
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