9. Epidural, subdural and intracerebral hematoma; symptoms, diagnosis and treatment Flashcards
What are signs of raised intracranial pressure?
- Headache
- Vomiting
- Impaired consciousness
- Papillo-edema
- Siezures
- Bradycardia & hypertension (late sign)
How can you lower ICP?
- Elevate head by 30°
- Hyperventilation 25 – 30 mmHg
- Mannitol (monitor osmolality)
- Corticosteroids (if edema is present)
- Fluid restriction
- Cool to 35°C
- Avoid hyperglycemia
- Sedation
- Surgery
What is the etiology of epidural hemorrhages?
ARTERIAL → fast bleed
Traumatic brain injury of temporal bone causing a rupture of the middle meningeal artery
What is the radiological sign of epidural hemorrhages?
BICONVEX, Lens shaped hematoma
What is the lucidum intervalum?
The period of conciousnouss after the loss of conciousness of the concussion
but before the loss of conciousness due to the increase in ICP because of the epidural hematoma
What is the treatment of epidural hemorrhages?
IMMEDIATE SURGERY
EMERGENCY craniotomy
What is the etiology of subdural hemorrhages?
VENOUS → slow bleed
Falls in elderly people causing a rupture of the bridging veins
What is the radiological sign of subdural hemorrhages?
Crescent shaped hematoma
What is the treatment of subdural hemorrhages?
Conservative (many people live with chronic versions)
ICP monitoring
Surgery if there is a midline shift on a CT but prognosis is bad
What is the etiology of intracerebral hemorrhages?
Bursting of an aneurysm (berry aneurysm)
