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Neurology Week 5 2018/19 > 3: Intracranial haemorrhage > Flashcards

3: Intracranial haemorrhage Flashcards

1
Q

Intracranial haemorrhage can be spontaneous or brought on by a ___ ___.

A

head injury

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2
Q

What underlying pathology is usually responsible for subarachnoid haemorrhage?

A

Berry aneurysm

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3
Q

What is a congenital problem which can cause subarachnoid haemorrhage?

A

AVM

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4
Q

The subarachnoid space is found between the ___ and the ___.

A

arachnoid, pia

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5
Q

Which type of haemorrhage is relatively common and may be related to a Berry aneurysm?

A

Subarachnoid haemorrhage

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6
Q

Which circulation does a Berry aneurysm affect?

A

Circle of Willis

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7
Q

Where in the Circle of Willis do Berry aneurysms tend to form?

A

Bifurcations

branch points between one artery and the next

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8
Q

What is the presentation of a subarachnoid haemorrhage?

A

Headache - sudden & severe; “worst headache of my life”; persistent

Syncope

Vomiting - almost always

Neck pain - irritation of meninges in spinal cord subarachnoid space

Photophobia - “”

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9
Q

Subarachnoid haemorrhage and meningitis have similar presentations.

How do you tell the difference?

A

Subarachnoid haemorrhage presents with sudden onset headache

Meningitis headache has a gradual onset

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10
Q

Why do headaches seen in subarachnoid haemorrhage have a sudden onset?

A

Aneurysm collapses and SYSTOLIC BP transferred into parenchyma (i.e it occurs very quickly)

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11
Q

What type of meningitis is caused by subarachnoid haemorrhage?

A

Chemical meningitis - due to the blood

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12
Q

Which type of headache may mimic that of a subarachnoid haemorrhage?

How would you tell the difference?

A

Migraine

Aura

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13
Q

What is benign coital cephalgia?

A

Sudden onset headache during / after sex

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14
Q

What are the clinical signs of subarachnoid haemorrhage?

A

Neck stiffness

Photophobia

Reduced conscious level

Focal neurological deficit e.g CN palsy

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15
Q

Which cranial nerve palsy is associated with brain aneurysms?

Which artery is implicated?

A

CN III palsy“down and out”

Posterior communicating artery

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16
Q

What is the first-line investigation for patients with subarachnoid haemorrhages?

A

CT brain

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17
Q

Is a CT brain 100% specific for subarachnoid haemorrhage?

A

No

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18
Q

What colour is fresh blood on a CT scan?

A

White

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19
Q

What colour is CSF on a CT scan?

A

Black

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20
Q

Where will blood be seen on a CT brain of someone with a subarachnoid haemorrhage?

A

Fissures, cisterns

i.e not in the ventricles

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21
Q

A CT brain is the first-line investigation for subarachnoid haemorrhage, but it may be negative.

What is the gold standard investigation?

What is seen in subarachnoid haemorrhage?

A

Lumbar puncture

Bloody / “xanthochromic” CSF

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22
Q

What is xanthochromia in terms of a CSF sample?

A

Yellow-ish staining of CSF - blood breakdown products; indicative of subarachnoid haemorrhage

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23
Q

How do you tell the difference between bloodstained CSF (in subarachnoid haemorrhage) and a traumatic tap?

A

Take three samples

if amount of blood decreases with each tap, it’s traumatic

24
Q

Which imaging can be used to visualise blood vessels in cerebrovascular disease?

A

CT / MRI angiography

25
Q

How long does bleeding actually last for in a subarachnoid haemorrhage?

A

< 1 second

because of compression, vasospasm etc. closing the bleed

26
Q

Aneurysms which have burst are at major risk of ____ in the next two weeks.

A

rebleeding

fatal complication of subarachnoid haemorrhage

27
Q

How is rebleeding prevented in patients with ruptured cerebral aneurysms?

A

Endovascular techniques

feeding through a catheter and planting metal coils

28
Q

Metal coils are implanted using a catheter to prevent ___ of ruptured aneurysms.

A

rebleeding

29
Q

Apart from endovascular techniques, what else can be used to stop aneurysms from rebleeding?

A

Surgical clips

30
Q

What is a complication of subarachnoid haemorrhage which can occur 3 - 12 days following a bleed?

A

Delayed ischaemia

31
Q

What causes delayed ischaemia following subarachnoid haemorrhage?

A

Vasospasm

32
Q

How is delayed ischaemia prevented?

A

High fluid intake - dehydration increases chances of vasospasm

Nimodipine - CCB which decreases chances of vasospasm

33
Q

How does delayed ischaemia present in patients following a subarachnoid haemorrhage?

A

Global - reduced conscious level

or focal neurological deficit

34
Q

How does infarction look on brain imaging?

A

Black

35
Q

Why can subarachnoid haemorrhage cause hydrocephalus?

A

Bleeding into SS increases CSF pressure > ICP

Blood clogs up subarachnoid granulations, reducing reabsorption

36
Q

How is hydrocephalus secondary to subarachnoid haemorrhage treated?

A

CSF drainage

either temporary: lumbar puncture

or permanent: shunt

37
Q

Which metabolic problem is seen following subarachnoid haemorrhage?

Which brain structure is thought to cause this?

A

Hyponatraemia

Hypothalamus

38
Q

Which two processes are thought to cause hyponatraemia in patients following a subarachnoid haemorrhage?

A

SIADH - something to do with the hypothalamus

Cerebral salt wasting

39
Q

Which artery supplies the hypothalamus?

A

Anterior communicating artery

40
Q

How is hyponatraemia following subarachnoid haemorrhage managed?

A

Fludrocortisone - aldosterone analogue, increases Na+ reabsorption by kidneys

Na+ supplements

NO fluid restriction

41
Q

Should patients with hyponatraemia following subarachnoid haemorrhage be fluid restricted?

A

No

42
Q

What is the biggest clinical feature of subarachnoid haemorrhage?

A

Headache - sudden onset, severe, constant

43
Q

How is subarachnoid haemorrhage managed initially?

A

Analgesia

Fluids

Anti-emetic

44
Q

How is subarachnoid haemorrhage investigated?

A

CT brain

Lumbar puncture

+/- angiography

45
Q

What is bleeding into the brain parenchyma called?

A

Intracerebral haemorrhage

46
Q

Most haemorrhagic strokes are caused by (subarachnoid / intracerebral) haemorrhages.

A

intracerebral

47
Q

What is the biggest risk factor for intracerebral haemorrhage?

A

Hypertension

48
Q

Which type of aneurysm is associated with intracerebral haemorrhage?

What risk factor causes them to develop?

A

Charcot-Bouchard aneurysms

Hypertension

49
Q

What are the symptoms of intracranial haemorrhage?

A

Headache

Focal neurological deficit

Decreased conscious level if severe

50
Q

How is intracranial haemorrhage investigated?

A

CT brain

Angiography

51
Q

What can be seen on a CT scan of someone with an intracranial haemorrhage?

A

Haematoma(s)

52
Q

Under which circumstances are patients with intracerebral haemorrhage operated on?

A

Decreased conscious level

Evidence of AVM

otherwise management is non-surgical

53
Q

Which brain structures, responsible for modifying movement information, may be involved in an intracerebral haemorrhage?

A

Basal ganglia

54
Q

What is an intraventricular haemorrhage?

A

Blood in the ventricles

55
Q

How does an intraventricular haemorrhage look on head imaging?

A

White (lucent) blood in the ventricles

as patients are lying on their backs for the scan, CSF rises to the top, so sorta a black/white divide in the ventricles

56
Q

Which type of haemorrhage do AVMs tend to cause?

A

Intracerebral haemorrhage

Neurology Week 5 2018/19 (11 decks)

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