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SO-Nervous System > Acute Intracranial Events > Flashcards

Acute Intracranial Events Flashcards

1
Q

What is an extradural haemorrhage?

A

Collection of blood between inner surface of skull, and periosteal dura mater

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2
Q

What causes extradural haemorrhagers?

A

Nearly always secondary to trauma and/or skull fracture

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3
Q

Who do extradural haemorrhages typically occur in?

A

Younger patients

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4
Q

What % of extradural haemorrhage cases involve a severed artery?

A

90%

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5
Q

What artery is most commonly severed in extradural haemorrhages?

A

Middle meningeal artery

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6
Q

How common is venous involvement in extradural haemorrhages?

A

Rare

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7
Q

What is venous involvement in extradural haemorrhages usually the rest of?

A

Torn venous sinus

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8
Q

What % of extradural haemorrhages are supratentorial?

A

95%

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9
Q

How do patients with extradural haemorrhages present?

A

Loss of consciousness, due to impact of injury

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10
Q

What happens after the initial loss of consciousness in a patient with an extradural haemorrhage?

A
  • There is a transient recovery with ongoing haemorrhage, known as the lucid interval in 40% of patients
  • As haemotoma enlarges, ICP will increase, causing compression of the brain and rapidly deterorating level of consciousness
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11
Q

What might be found on examination in a patient with a progressing extradural haemorrhage?

A

Cranial nerve palsies

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12
Q

Why might cranial nerve palsies present in patients with extradural haemorrhages?

A

Due to herniation of brain structures

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13
Q

What is the prognosis of an extradural haemorrhage?

A

Generally good with early intervention

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14
Q

How is a small extradural haemorrhage managed?

A

Observed and managed conservatively, with neurological follow up

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15
Q

How is a large extradural haemorrhage managed?

A

Referral to neurosurgery for craniotomy and clot evacuation

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16
Q

What are the potenital complications of extradural haemorrhages?

A
  • Pernament brain damage
  • Coma
  • Seizures
  • Weakness
  • Pseudoaneurysm
  • Arteriovenous fistula
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17
Q

What is a subdural haemorrhage?

A

Collection of blood between meningeal dura mater and arachnoid mater

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18
Q

What age groups can subdural haemorrhages occur in?

A

All

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19
Q

What are the categories of subdural haemorrhages?

A
  • Acute (<3 days)
  • Subacute (3-21 days)
  • Chronic (>3 weeks)
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20
Q

Why does bleeding occur in a subdural haemorrhage?

A

Due to shearing forces on cortical bridging veins

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21
Q

What causes subdural haemorrhages?

A

Most often associated with trauma, but can be spontaneous

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22
Q

What increases the risk of rupture of subdural haemorrhages?

A

Cerebral atrophy

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23
Q

What setting do acute subdural haemorrhages usually present?

A

Head trauma

24
Q

What % of acute subdural haemorrhage patients present with neurological abnormalities?

A

Up to 80%

25
Q

Who is subacute/chronic subdural haemorrhages more common in?

A

The elderly, with vague or absent history of head trauma

26
Q

How might subacute/chronic subdural haemorrhages present?

A

With insidious onset of confusion and general cognitive decline similar to dementia

27
Q

How do acute subdural haemorrhages appear on CT?

A

Generally, hyperdense i.e. brighter than brain tissue

28
Q

What happens to the CT appearance of haemotoma caused by a subdural haemorrhage over time?

A

It will progressively become hypodense, i.e. darker than brain tissue

29
Q

How can small chronic haematomas caused by subdural haemorrhages be evaluated?

A

Serial imaging

30
Q

What do collect subdural haemorrhages require?

A

Immediate neurosurgical intervention

31
Q

How are symptomatic subacute/chronic subdural haemorrhages treated?

A

Via one or more burr holes

32
Q

What is the prognosis of subdural haemorrhages?

A

Relatively poor compared to extradural haemorrhages

33
Q

What is the mortality in acute subdural haemtomas requiring surgery?

A

May exceed 50%

34
Q

What patients have worse outcomes of subdural haemotomas?

A

Those who are anticoagulated

35
Q

What % of patients recover fully from subdural haemorrhages?

A

20%

36
Q

Describe the shape of an extradural haemorrhage

A

Lentiform / biconvex, e.g. like a lemon

37
Q

Describe the shape of a subdural haemorrhage?

A

Crescent / sickle, e.g. like a banana

38
Q

What is a subarachnoid haemorrhage?

A

Collection of blood between the arachnoid mater and the pia mater

39
Q

In whom do subarachnoid haemorrhages usually occur?

A

Middle aged patients, <60

40
Q

What causes subarachnoid haemorrhages?

A
  • Vast majority occur spontaneously, secondary to ruptured berry aneurysms
  • May be traumatic
41
Q

How do patients with a subarachnoid haemorrhages present?

A
  • Sudden onset ‘thunderclap’ headache
  • Meningism
  • Nausea and vomiting
  • Fever
  • Focal neurological deficits
  • LOC
42
Q

What are the symptoms of berry aneurysms?

A

Largely asymptomatic, but symptoms may arise if compressing nearby structures, or during early stages of rupture

43
Q

What % of the population have one or more berry aneurysm?

A

Around 3%

44
Q

What can be done to berry aneurysms with a high risk of rupture?

A

Surgical clipping and endovascular coiling

45
Q

What are the risk factors for berry aneurysms?

A
  • Family history
  • Hypertension
  • Heavy alcohol consumption
  • Abnormal connective tissue
46
Q

Give 4 examples of abnormal connective tissue diseases

A
  • Autosomal dominant polycystic kidney disease
  • Erlers-Danlos
  • Neurofibromatosis
  • Marfan’s disease
47
Q

What % of berry aneurysms form in the anterior cerebral artery?

A

40%

48
Q

What % of berry aneurysms form at the junction of the internal carotid artery with the posterior communicating artery

A

20%

49
Q

What % of berry aneurysms form in the middle cerebral artery?

A

34%

50
Q

What % of berry aneurysms occur at the bifurcation of the basilar artery?

A

4%

51
Q

What is performed to aid diagnosis of a subarachnoid haemorrhage?

A

Lumbar puncture

52
Q

What is looked for in the lumbar puncture that might suggest a diagnosis of subarachnoid haemorrhage?

A
  • Presence of RBCs
  • Xanthochromia
53
Q

How are subarachnoid haemorrhages managed?

A
  • Stabilise the patient
  • Prevent rebleeding
  • Treat cerebral vasospasm
  • Correct hyponatraemia
  • Neurosurgical intervention if large bleed
54
Q

What does the prognosis of subarachnoid haemorrhages depend on?

A
  • GCS
  • Degree of neurological deficit at the time of presentation
  • Co-morbidities
55
Q

What is the mortality of subarachnoid haemorrhages?

A

Between 30 and 90%

56
Q

What are the complications of subarachnoid haemorrhages?

A
  • Hydrocephalus
  • Focal neurological deficits
  • Coma
  • Seizures
  • Cognitive decline
  • Frequent headaches
  • Hypopituitarism

SO-Nervous System (18 decks)

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