By Dr. Sara J. Cuccurullo MD
I have been in inner most perform for 10years, yet were out of PMR perform for approximately eight years. i used this article completely for the recertification forums and handed with flying colors.
if your basic objective is to cross the recertification board, this is often ALL YOU NEED.
secondarily, i might imagine it's a great quickly referrence for daily pmr subject matters.
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Head CT with contrast: IV contrast provides no brain enhancement in day 1 or 2, as it must wait for enough damage to the blood brain barrier; more evident in 1–2 weeks. Changes disappear 2 to 3 months later. • Some studies suggest worse prognosis for patients receiving IV contrast early. • Hemorrhage can occur within an infarcted area where it will appear as a hyperdense mass within the hypodense edema of the infarct. Hemorrhagic Infarct: • High density (white) lesion seen immediately in ~ 100% of cases.
Emergent head CT scan – Because the clinical picture of hemorrhagic and ischemic stroke may overlap, head CT scan without contrast is needed in most cases to definitively differentiate between the two. – One of the criteria that determines whether patient is a candidate for emergent thrombolytic therapy. – Impaired level of consciousness/coma: if there is acute deterioration of level of consciousness, evaluate for hematoma/acute hydrocephalus. Treatment would be emergency surgery. – Rule out hemorrhage in the presence of an underlying coagulopathy.
Most of the lateral aspect of the hemisphere is supplied mainly by the middle cerebral artery. 2. The anterior cerebral artery supplies the medial aspect of the hemisphere from the lamina terminalis to the cuneus. 3. The posterior cerebral artery supplies the posterior inferior surface of the temporal lobe and the visual cortex. STROKE n FIGURE 1–5 Major vascular territories are shown in this schematic drawing of a coronal section through the cerebral hemisphere at the level of the thalamus and the internal capsule.