3.2.2 Intracranial Haemorrhages Flashcards
What are the 3 types of intracranial haemorrhage?
Extradural
Subdural
Subarachnoid
Where else can bleeding occur intracranially?
Within the brain tissue itself, e.g. tearing of white matter
Intracerebral haemorrhage
What is the major problem within intracranial bleeding?
Adding volume to fixed space increases the pressure
Leads to damage to brain tissue,brainstem and cranial nerves
What is an extradural haemorrhage?
- Arterial bleed, most often caused by MMA due to pterion knock
- Biconvex shape (lemon-shaped)
Why does an extradural haemorrhage have a biconvex shape?
Periosteal layer stripped from inner table of skull due to bleeding
Periosteal layer cannot easily be stripped at suture edges so the bleed gets pinched
How do patients present with an extradural haemorrhage?
Lose conciousness after major trauma
Feel fine afterwards for a while (lucid interval)
Sudden rapid decline
Can happen to any age group
What is a subdural haemorrhage?
Venous bleed
SuBdural
Brain veins-Bridging veins
Banana shaped
How do subdural haemorrhages occur?
Bridging veins snap as they join walls of the dura
More common in the elderly as cerebral atrophy increases the tension on weak veins
Venous blood leaks into subdural space, ipsilateral due to dural folds
How do patients with subdural haemorrhages present?
Trauma to head, days before
Can lose conciousness
Bad headache
Slow, gradual decline over days
What is a subarachnoid haemorrhage?
Arterial bleed
Trauma or vessel rupture e.g. from aneurysm in circle of Willis
Blood in subarachnoid space mixes with CSF and irriates the brain
Can cause meningism and worst ever headache
How do you investigate a subarachnoid haemorrhage?
CT-100% picked up if within 6 hours
93% if over 24 hours, faster the better
Lumbar puncture, check for Hb degradation products (do this if cannot easily tell on CT)
