Bleeds in the brain

Question 1

Intracranial bleed

Answer 1

10-20% strokes are caused by an intracranial bleed.

risk factors:
Head injury
Hypertension
Aneurysms
Ischaemic stroke can progress to haemorrhage
Brain tumours
Anticoagulants such as warfarin

Question 2

layers of the skull:

DASP

Answer 2

skull
dura matter
arachoind matter
subarachonid matter
pia matter
brain

Question 3

presentation of intracranial bleed

Answer 3

sudden onset headache
Seizures
Weakness
Vomiting
Reduced consciousness
Other sudden onset neurological symptoms

Question 4

subdural haemorrhage

Answer 4

rupture of the bridging veins
bleeding occurs between the dura matter and arachnoid matter
CT- crescent shape
not limited byt he cranial sutures

*elderly
*alcoholic
(atrophy- rupture)

Question 5

extradural haemorrhage

Answer 5

rupture of the middle meningeal artery in the tempo-parietal region

fracture of temporal bone
bleeding between skull and dura mater
CT- bi convex shape. limited by the cranial sutures.

traumatic head injury with an ongoing headache. improvement of neurological symptoms and consciousness then rapid decline (As haematoma gets large enough to compress intracranial contents)

Question 6

intracerebral haemorrhage

Answer 6

bleeding into the brain tissue. presents similarly to an ischaemic stroke.
These can be anywhere in the brain tissue:

Lobar intracerebral haemorrhage
Deep intracerebral haemorrhage
Intraventricular haemorrhage
Basal ganglia haemorrhage
Cerebellar haemorrhage
They can occur spontaneously or as the result of bleeding into an ischaemic infarct or tumour or rupture of an aneurysm.

Question 7

subarachnoid haemorrhage

Answer 7

bleeding into the subarachnoid space where CSF is located (between pia mater and arachnoid membrane)

ruptured cerebral aneurysm

occipital headache after strenuous exercise (weight living, sex)

THUNDERCLAP HEADACHE
Neck stiffness
Photophobia
Vision changes
Neurological symptoms such as speech changes, weakness, seizures and loss of consciousness

*cocaine, sickle cell anaemia

Question 8

bleed in brain management

Answer 8

Immediate CT head to establish the diagnosis
Check FBC and clotting
Admit to a specialist stroke unit
Discuss with a specialist neurosurgical centre to consider surgical treatment
Consider intubation, ventilation and ICU care if they have reduced consciousness
Correct any clotting abnormality
Correct severe hypertension but avoid hypotensio

Question 9

investigations for subarachnoid haemorrhage

Answer 9

• CT head: hyperattenuating in the subarachnoid space
• Lumbar puncture- collect CSF. Red cell count will be raised. If the cell count is decreasing in number over the samples, this could be due to a traumatic lumbar puncture.
  Xanthochromia (the yellow colour of CSF caused by bilirubin)
• Angiography (CT/MRI) to locate source of bleeding.

Question 10

subarachnoid management

Answer 10

specialist neurosurgical nit
intubate/ventilate if LOC

surgical intervention: coiling (endovascular approach) with platinum coils into the aneurysm to seal it off from the artery. alternatively, clipping

nimodepine- ca2+ channel blocker to prevent vasospasm.

lumbar puncture- insertion of a shunt to treat hydrocephalus

antiepileptic meds- to treat seizures.