Brain Bleeds and Haemorrhages Flashcards
What does a subarachnoid haermorrhage involve
Bleeding into the subarachnoid space where the CSF is located (pia mater and archnoid mater)
Usual cause of subarachnoid haemorrhage
Ruptured cerebral aneurysm
History of subarachnoid haemorrhage
Sudden onset occipital headache that occurs during strenuous activity. ‘thunderclap headache’
Features of subarachnoid haemorrhage
Neck stiffness, photophobia, vision changes, neurological symptoms such as speech change, weakness, seizures, loss of consciousness
Risk factors for subarchnoid haemorrhage
HTN, smoking, excessive alcohol consumption, cocaine use, family history
What population groups are subarachnoid haemorrhages more common in
Black patients, females and age 45-70
What are subarachnoid haemorrhages particularly associated with
Cocaine use, sickle cell anaemia, connective tissue disorders, neurofibromatosis, autosomal dominant PCKD
CT scan of subarachnoid haemorrhage
Hyperdense area in centre of brain expanding bilaterally.
LP in subarachnoid haemorrhage
If CT is negative CSF can be tested for signs - RCC raised, xanthochromia
What is done to locate the source of subarachnoid haemorrhage
CT or MRI angiography
Management of subarachnoid haemorrhage
Surgical intervention, Nimodipine, LP and antiepileptic medications
Surgicaal interventions used to treat subarachnoid haemorrhage
Coiling or clipping
What does surgical coiling involve
Inserting a catheter into the arterial system, placing platinum coild into aneurysm and sealing it off from artery
What does surgical clipping involve
Involves cranial surgery and putting clip on the aneurysm to seal it off
What is the role of Nimodipine in subarachnoid haemorrhages
Calcium channel blocker which is used to prevent vasospasm - a common complication that can result
Why is an LP used in management of subarachnoid haemorrhage
To treat hydrocephalus
Risk factors for intracranial bleeds
Head injury, HTN, aneurysms, ischaemic stroke can progress to haemorrhage, brain tumours, anticoagulants
Types of intracranial bleeds
Subdural, extradural, intracerebral and subarchnoid
Where is the bleed in subdural haemorrhage
Dura and arachnoid mater
Causes of subdural haemorrhage
Rupture of bridging veins
Presentation of subdural haemorrhage
Acute or chronic, tending to present gradually with increasing headache and confusion.
Who are subdural haemorrhages more likely to occur in
Elderly patients and alcoholic due to atrophy in brain
Causes of subdural haemorrhage
History of trauma, alcohlism and anticoagulation, accerlation-deceraltion injury
What does subdural haemorrhage look like on CT
Crescent shape, following contours of skull as it is not limited by cranial sutures
Difference between acute and chronic subdural haemorrhage on CT
Hyperdense is acute, and hypodense is chronic
Where is the bleed in an extradural haemorrhage
Skull and dura mater
Cause of extradural haemorrhage
Trauma to pterion, associated with fracture to temporal bone
Which vessels bleeds in extra dural haemorrhage
Middle meningeal artery
History of extradural haemorrhage
Young patient with traumatic head injury that has ongoing headache. Period of improved symptoms and consciousness followed by rapid decline as haematoma compresses intracranial contents
Symptoms of extradural haemorrhage
Acute severe headache, loss of consciousness, lucid interval then rapid deterioration
CT image of extradural haemorrhage
Hyperdense bioconvex shape limited by cranial sutures
Where is an intracerebral haemorrhage
Bleeding into the brain tissue
Presentation of intracerebral haemorrhage
Similar to ischaemic stroke
Which areas of brain tissue can be affected
Lobar, deep intracerebral, intraventricular, basal ganglia and cerebellar
Causes of intreacerebral haemorrhage
Spontaneously or as a result of bleeding into an ischaemic infarct or tumour or rupture of aneurysm
