A to E: Disability - Extra-axial haemorrhage Flashcards

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1
Q

Name the three types of extra-axial haemorrhage

A
  • Extradural haemorrhage
  • Subdural haemorrhage
  • Subarachnoid haemorrhage (SAH)
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2
Q

Outline the anatomy of the meninges

A
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3
Q

What vessel is damaged in an extradural haematoma?

A

Middle meningeal artery

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4
Q

Give two presenting features of an extradural haemorrhage

A
  • Usually precipitated by clearly defined head trauma
    • Young patient involved in sport or RTA
  • Potential TLOC ➔ Lucid interval ➔ Gradual LOC
  • Ongoing severe headache
  • CNVI palsy as downward herniation begins
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5
Q

Describe the CT head findings of an extradural haemorrhage

A
  • Bi-convex (lentiform) shape
  • Usually limited by cranial sutures
  • Hyperdense; sharply demarcated
  • Swirl sign: active bleeding
  • Secondary features of mass effect
    • Midline sift
    • Subfalcine herniation
    • Uncal herniation
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6
Q

Outline the management of an extradural haemorrhage

A
  • Conservative: small without mass effect or swirl sign
  • Mannitol: reduce RICP
  • Craniotomy and evacuation
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7
Q

What vessel is damaged in a subdural haemorrhage?

A

Tearing of bridging cortical veins

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8
Q

Give two presenting features of a subdural haemorrhage

A
  • Usually occurs with head trauma
    • RTAs; falls (minor trauma)
  • Initially asymptomatic
  • Neurology upon osmotic reactivation as clot breaksdown
    • Severely reduced GCS
    • Pupillary abnormalities
  • Subacte/chronic subdural: elderly; absent/minor head trauma
    • Pseudodementia
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9
Q

Describe the CT head findings of an subdural haemorrhage

A
  • Not limited by cranial sutures
  • Spread diffusely over affect hemisphere
  • Acute:
    • Crescent-shaped
    • Hyperdense
  • Chronic: 3+ weeks old
    • Crescentic or biconvex
    • Hypodense
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10
Q

Outline the management of subdural haemorrhages

A
  • Small; chronic; asymptomatic
    • Active monitoring
  • Symptomatic
    • Acute: Craniotomy + evacuation
    • Subacute/chronic: Burr holes
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11
Q

Differentiate between an extradural haemorrhage from a subdural haemorrhage

A
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12
Q

Name two causes of subarachnoid haemorrhage

A
  • Trauma
  • Spontaneous
    • Ruptured berry aneurysm
    • Arteriovenous malformation
    • Infected aneurysm
    • Pituitary apoplexy
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13
Q

Name four risk factors for subarachnoid haemorrhage

A
  • FHx
  • HTN
  • Alcohol abuse
  • Connective tissue disorders
    • ADPKD
    • Ehlers-Danlos disease
    • Marfan syndrome
  • Female
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14
Q

Give three presenting features of a subarachnoid haemorrhage

A
  • Middle-aged patients
  • Thunderclap headache: sudden-onset; worst headache
  • Meningism
    • Neck stiffness; Kernig sign; Brudzinski sign
    • Photophobia
    • Fever
    • NaV
  • Focal neurological deficits
  • Collapse; reduced GCS; LOC
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15
Q

Describe the CT findings of a subarachnoid haemorrhage

A
  • Hyperdensity
  • Subarachnoid space:
    • Within cisterns
    • Brain and the sulci
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16
Q

What investigation is needed if CT head is negative for suspected subarachnoid haemorrhage?

A

Lumbar puncture after 12hrs

Assess for xanthochromia (bilirubin in CSF)

Fresh blood in CSF can be from traumatic LP

17
Q

Outline the management of subarachnoid haemorrhage

A
  • Treatment varies depending on underlying cause
    • Ruptured aneurysm: aneursym coiling
  • Cerebral vasospasm
    • Triple H therapy: Haemodilution; HTN; Hypervolaemia
    • CCBs: Nimodipine
    • Nitric oxide; ballon angioplasty