Neurology · USMLE Step 1 and Step 2

Hemorrhagic Stroke song

Hemorrhagic Stroke - Intracerebral vs SAH, as a song. Hear the short teaser here. The full song is on YouTube and Spotify.

Hemorrhagic Stroke

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Key points in this song10

Hypertensive intracerebral hemorrhage most commonly occurs in the putamen (basal ganglia), followed by thalamus, pons, and cerebellum, due to rupture of Charcot-Bouchard microaneurysms in small penetrating arteries.
A patient with sudden-onset "worst headache of my life" (thunderclap headache) requires immediate non-contrast CT head; if negative, lumbar puncture showing xanthochromia confirms subarachnoid hemorrhage (SAH).
The most common cause of spontaneous SAH is rupture of a saccular (berry) aneurysm, most frequently at the junction of the anterior communicating artery and anterior cerebral artery.
Berry aneurysms are associated with autosomal dominant polycystic kidney disease (ADPKD), Ehlers-Danlos syndrome, Marfan syndrome, and coarctation of the aorta.
A posterior communicating artery aneurysm classically presents with a painful, isolated CN III palsy (ptosis, "down-and-out" eye, mydriasis) due to compression of the parasympathetic fibers on the outer nerve surface.
Vasospasm is the leading cause of delayed neurological deterioration 4–14 days after SAH; nimodipine (a calcium channel blocker) is given prophylactically to reduce vasospasm-related ischemia.
Cerebral amyloid angiopathy (CAA) is the most common cause of lobar hemorrhage in normotensive elderly patients, due to β-amyloid deposition in cortical vessel walls.
Re-bleeding is the most feared immediate complication of SAH; definitive treatment is surgical clipping or endovascular coiling of the aneurysm to prevent rerupture.
Hypertensive hemorrhage in the cerebellum presents with sudden occipital headache, vomiting, ataxia, and ipsilateral gaze palsy; it is surgically evacuated if >3 cm due to risk of brainstem compression and obstructive hydrocephalus.
Sentinel headache — a sudden severe headache days to weeks before major SAH — represents a small "warning leak" and must not be dismissed, as early intervention prevents catastrophic rebleed.