5.3 Intracranial haemorrhage Flashcards
SO severe headache collapse vomiting neck pain photophobia
Subarachnoid haemorrhage
ddx sudden onset headache
SAH
migraine
benign coital cephalgia
when can CT brain be negative post -SAH?
if >3 days post-ictus
negative in 15% of pts who have bled anyways
when is LP safe?
- alert pain + no focal neuro deficit + no papilloedema
OR - after normal CT scan
When can you find xanthochromic CSF?
6-48 hours post-ictus
differentiate it from a traumatic tap
complications of SAH
re-bleed delayed ischaemic deficit (stroke!) hydrocephalus hyponatraemia seizures
when is re-bleed risk higher?
- first 14 days or
- first 6 months?
trick question
-20% risk of re-bleed is in first 14 days
then it accumulates to
-50% risk of bleed in first 6 months
high risk period for delayed ischaemia
days 3-12
management of delayed ischaemia
nimodipine
high fluid intake
triple H therapy - hypertension, hypervolaemia, haemodilution
how do you manage hyponatraemia/SIADH in intracranial haemorrhage?
do not fluid restrict
supplement Na+ intake
fludrocortisone
major causes of intracerebral haemorrhage
50% due to HTN
30% due to aneurysm or AVM
what is charcot-bouchard?
microaneurysms arising on small perforating arteries
presentation of ICH?
headache
focal neuro deficit
decreased LOC
tx of ICH
surgical evauation of haematoma
treat underlying abnormality
or - non-surgical mx
poor px indicators of ICH
large basal ganglia or thalamic clot
major focal deficit or deep coma
