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1(E) Intracranial Haemorrhage Flashcards

1
Q

What is intracranial haemorrhage

A

Bleeding within ventricles

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2
Q

In which population does intraventricular haemorrhage occur

A

Pre-mature neonates

Rare in adults

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3
Q

Why does intraventricular haemorrhage happen in pre-mature neonates

A

Due to pre-maturity of periventricular vessels

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4
Q

What can cause inter ventricular haemorrhage in adults

A
  • Extension SAH

- Vascular lesions (AV malformation, Aneurysm)

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5
Q

In pre-mature neonates, when will intraventricular haemorrhage occur

A

Several days following birth

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6
Q

What is the management of intraventricular haemorrhage

A

VP Shunt to divert CSF

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7
Q

What is the main complication if intraventricular haemorrhage

A

Obstructive hydrocephalus

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8
Q

What is subarachnoid haemorrhage

A

Bleeding into subarachnoid space

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9
Q

What are the two etiological categories of SAH

A
  • Traumatic

- Non-traumatic

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10
Q

What is the most common cause of SAH

A

Most common

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11
Q

What is the most common cause of non-traumatic SAH

A

Berry aneurysm

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12
Q

In which gender are berry aneurysms more common

A

Female (3:2)

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13
Q

In which artery are berry aneurysms more common

A

Anterior communicating artery

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14
Q

What are 4 other causes of SAH

A
  • AV malformation
  • Pituitary apoplexy
  • Mycotic aneurysm
  • Carotid artery dissection
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15
Q

Give 3 conditions associated with berry aneurysm formation

A

ADPKD
Ehlers-Danlos
Coarctation aorta

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16
Q

What are 4 risk factors for berry aneurysm

A 
Smoking
Cocaine and amphetamine use 
HTN
Alcohol 
FH
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17
Q

How does SAH present clinically

A
  • Sudden-onset occipital thunderclap headache - sentinel headache beforehand.
  • Nausea and Vomitting
  • LOC
  • Seizures

Meningism:

  • Stiff neck
  • Headache
  • Photophobia
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18
Q

What are signs of meningism

A

Brudzinski

Kernig

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19
Q

When is Kernig sign first positive

A

6-hours following onset

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20
Q

What syndrome is associated with SAH

A

Terson syndrome

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21
Q

What is Terson’s syndrome

A

Retinal, Subhyaloid and vitreous bleeds

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22
Q

What is the problem with Terson’s syndrome

A

5-times risk of mortality

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23
Q

What ECG changes are present in SAH

A

ST elevation

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24
Q

What immediate investigation is ordered in SAH

A

CT-head

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25
Q

What other investigation is ordered in SAH

A

CT angiography

LP

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26
Q

When is LP performed

A

12 hours afterwards

27
Q

What is looked for on LP

A

Xanthrochromia

28
Q

How long does xanthochromia remain high for

29
Q

What other finding on LP may support diagnosis of SAH

A

High opening pressure

30
Q

What should be done immediately in SAH

A

Urgent referral to neurosurgery

31
Q

What medication is given for SAH

A

Nimodipine

32
Q

How do neurosurgery treat SAH

A

Endovascular coiling

33
Q

What is an alternative to endovascular coiling

A

Craniotomy and surgical clipping

34
Q

How is any hydrocephalus managed

A

External ventricular drain. Then managed long-term with VP shunt

35
Q

What is highest risk in first 24h following SAH

A

Re-bleeding

36
Q

What is highest risk in 7-14d following SAH

37
Q

What can vasospasm cause

A

Communicating hydrocephalus

38
Q

What is a metabolic complication of SAH

A

SIADH - leading to hyponatraemia

39
Q

What is a neurological complication of SAH

A

Seizures

Hydrocephalus

40
Q

What is subdural haemorrhage

A

Bleeding in dural space

41
Q

How are subdural haemorrhages classified

A

Acute: less than 4-days
Sub-acute: 4-21 days
Chronic: more than 21-days

42
Q

What causes subdural haemorrhage

A

Rupture of bridging veins from superficial cerebral surface to dural venous sinus

43
Q

What mechanism of injury usually causes subdural haemorrhage

A

Acceleration-Deceleration Injury
Shaken Baby Syndrome
Secondary to falls

44
Q

What increases risk of falls

A

Elderly

Alcoholic

45
Q

Explain trauma in subdural haemorrhage

A

Often individuals do not remember the initial trauma - as it is 9 months previously

46
Q

What two groups are at risk of subdural haemorrhage

A

Alcoholics

Elderly

47
Q

How does acute subdural haemorrhages present

A

Fluctuating consciousness
Personality change
Headache
Intellectual or physical impairment

48
Q

How does chronic subdural haemorrhage present

A

Week-month history of progressive confusion, reduced consciousness and neurological deficit

49
Q

What trauma causes acute subdural haematomas

A

High-impact

50
Q

What can acute subdural haemorrhages lead to

A

Acute haemorrhage can cause midline shift and raised ICP which leads to trans-tentorial herniation

51
Q

What investigation should be ordered for subdural haematoma

52
Q

What will be seen in acute subdural on CT

A

Hyperdense collection of blood
Cresenteric shape
Not limited by suture lines

53
Q

What will be seen in chronic subdural on CT

A

Hypodense collection of blood

54
Q

How are subdural haematomas managed

A

Burr-hole

Craniotomy

55
Q

What is an extradural haematoma

A

Bleeding between dura mater and skull

56
Q

What is peak demographic for extradural haemaotma

A

Male

20-30 years

57
Q

What causes extradural haematoma

A

Trauma to pterion

58
Q

What passes under pterion

A

Rupture middle meningeal artery

59
Q

Explain presentation of extradural haematoma

A

Individual has decrease in GCS. Then followed by a luck interval. Then deterioration in GCS and symptoms raised ICP:

  • Headache
  • N+V
  • Seizures
  • Fixed dilated pupil (CN3 compression)
  • Cushing’s reflex- bradycardia, hypotension, irregular respiration
60
Q

What indicates CN3 compression

A

Fixed mid-dilated pupil

61
Q

What investigation is ordered for extradural haematoma

62
Q

What will be seen on CT in extradural haematoma

A

Lemon shape hyperdennse collection

Limited by suture lines

63
Q

How are extradural haematomas managed

A

Burr Hole

Craniotomy

Neurology (26 decks)

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