A to E: Disability - Extra-axial haemorrhage Flashcards
Name the three types of extra-axial haemorrhage
- Extradural haemorrhage
- Subdural haemorrhage
- Subarachnoid haemorrhage (SAH)
Outline the anatomy of the meninges
What vessel is damaged in an extradural haematoma?
Middle meningeal artery
Give two presenting features of an extradural haemorrhage
- 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
Describe the CT head findings of an extradural haemorrhage
- 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
Outline the management of an extradural haemorrhage
- Conservative: small without mass effect or swirl sign
- Mannitol: reduce RICP
- Craniotomy and evacuation
What vessel is damaged in a subdural haemorrhage?
Tearing of bridging cortical veins
Give two presenting features of a subdural haemorrhage
- 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
Describe the CT head findings of an subdural haemorrhage
- Not limited by cranial sutures
- Spread diffusely over affect hemisphere
- Acute:
- Crescent-shaped
- Hyperdense
- Chronic: 3+ weeks old
- Crescentic or biconvex
- Hypodense
Outline the management of subdural haemorrhages
- Small; chronic; asymptomatic
- Active monitoring
- Symptomatic
- Acute: Craniotomy + evacuation
- Subacute/chronic: Burr holes
Differentiate between an extradural haemorrhage from a subdural haemorrhage
Name two causes of subarachnoid haemorrhage
- Trauma
- Spontaneous
- Ruptured berry aneurysm
- Arteriovenous malformation
- Infected aneurysm
- Pituitary apoplexy
Name four risk factors for subarachnoid haemorrhage
- FHx
- HTN
- Alcohol abuse
- Connective tissue disorders
- ADPKD
- Ehlers-Danlos disease
- Marfan syndrome
- Female
Give three presenting features of a subarachnoid haemorrhage
- 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
Describe the CT findings of a subarachnoid haemorrhage
- Hyperdensity
- Subarachnoid space:
- Within cisterns
- Brain and the sulci
What investigation is needed if CT head is negative for suspected subarachnoid haemorrhage?
Lumbar puncture after 12hrs
Assess for xanthochromia (bilirubin in CSF)
Fresh blood in CSF can be from traumatic LP
Outline the management of subarachnoid haemorrhage
- Treatment varies depending on underlying cause
- Ruptured aneurysm: aneursym coiling
- Cerebral vasospasm
- Triple H therapy: Haemodilution; HTN; Hypervolaemia
- CCBs: Nimodipine
- Nitric oxide; ballon angioplasty
