Bleeds

Question 1

What are the RFs for a subdural haematoma?

Answer 1

Physical abuse/non-accidental injury
Elderly (cerebral atrophy)
Alcoholics (falls risk)
Epileptics (falls risk)

Question 2

How does trauma cause a subdural?

Answer 2

Bleeding from bridging veins
Minor trauma
Confined between brain & dura

Question 3

How does a subdural present?

Answer 3

Chronic fluctuating consciousness + headache over several days
Personality change

Question 4

How does trauma cause an extradural?

Answer 4

Bleeding from middle meningeal artery

Due to temporal bone #- high impact injury

Question 5

How does an extradural present?

Answer 5

"Talk & die" sequale
LOC
Lucid interval w/ FULL recovery
Around 24hours neurological deterioration (bleed continues) +/- headache
Pupil asymmetry
Vomiting
30% die

Question 6

How is a subdural treated?

Answer 6

ABCDE
Burr hole craniostomy
Craniotomy

Question 7

How is an extradural investigated?

Answer 7

Xray: If # → CT head as high risk for extradural

Question 8

How is a extradural treated?

Answer 8

Urgent decompression- Surgery = NEUROSURGERY

ABCDE

Question 9

What are the causes of a subarachnoid?

Answer 9

70% Aneurysm (Berry)
AV Malformation
Rare: Clotting, tumour, vasculitis, polycystic kidney disease

Question 10

What do 20-50% of patients report before a SAH?

Answer 10

SENTINAL BLEED

Distinct, severe headache in days/weeks before

Question 11

How does SAH present?

Answer 11

Thunderclap headache
Sudden, severe, occipital, worse bending neck
Neck stiffness
N&V
Impaired consciousness, drowsy, confused
Focal neuro signs

Question 12

What scales can be used to assess severity of an SAH?

Answer 12

Hunt & Hess: Assess severity in relation to mortality

Fisher: Amount of SAH on CT & helps predict occurrence & severity of cerebral vasospasm

Question 13

What are the components of the Hunt & Hess Scale?

Answer 13

1) Mild Headache, Alert & Oriented
2) Full nuchal rigidity, mod-severe headache, no neuro deficit, alert & orientated
3) Lethargy/confusion, mild neuro deficit
4) Stupour, mod neuro deficit
5) Coma, severe neuro deficit (posturing)-90% MORTALITY

Question 14

How is a SAH investigated?

Answer 14

-Urgent CT head
CT -ve but Sx suggest → LP
-LP >12hours after onset: Xanthochromic CSF (bilirubin from Hb breakdown)

Question 15

How is an SAH managed?

Answer 15

ABCDE
URGENT REFERAL to neurosurgeons
Surgery: Endovascular coils/ surgical clips/ stenting
Analgesia: Codeine/Morphine
Metoclopramide
Aims:
↓Vasospasm: Nimodipine 
Laxative
Beta blocker
Hypotension: Colloid, inotropes