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Neurology > Brain haemorrhage > Flashcards

Brain haemorrhage Flashcards

1
Q

Are subarachnoid haemorrhages rare?

A

Yes only 100 per year in NI but important as can easily be fatal

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2
Q

What is a subarachnoid haemorrhage?

A

blood bursts from aneurysm into subarachnoid space

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3
Q

Define aneurysm?

A

Local dilation of a blood vessel wall

  • aneurysm have neck, body and dome
  • typically bursts at fundus as where there is
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4
Q

What are the symptoms of a subarachnoid haemorrhage

A
  • Thunderclap headache
  • vomiting
  • neck stiff
  • photophobia
  • seizure/loss of consciousness
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5
Q

What would be seen in examination of subarachnoid haemorrhage?

A
  • GCS (reduced GCS)
  • Pupils (bilateral fixed dilated)
  • CNs esp fundoscopy (can check for blood in eye)
  • PNS (may have focal deficit due to haemorrhage)
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6
Q

What does bilateral fixed dilated pupils mean?

A

high intracranial pressure will probably not survive

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7
Q

What are the risk factors for haemorrhage?

A
  • strong family history
  • smoking
  • hypertension
  • alcohol excess
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8
Q

How would symptoms of subarachnoid haemorrhage be investigated?

A
  • CT brain (asap)
  • needs to be as soon as possible as becomes less and less sensitive as time goes on
  • if nothing showing on CT then lumbar puncture can be taken at least 12h after
  • will be bilirubin in lumbar puncture
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9
Q

How do you take a lumbar puncture?

A
  • position on their side in foetal position to increase space for needle
  • aim for intraspinous space between L4 and L5 (as no spinal cord here)
  • sample taken must avoid light and be spun within 30 min (get oxyhaemoglobin peak masking haemoglobin otherwise)
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10
Q

When can lumbar punctures not be taken?

A
  • focal neurology and abnormal conscious level (if brain scan not taken) in case of tumour
  • coagulopathy
  • local infection at puncture site (as can spread)
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11
Q

What is the treatment of an aneurysm?

A
  • coiling (performed endovascularly) insert detachable platinum coil which packs the aneurysm
  • clipping (neurosurgery) clip inserted across the aneurysm, far more risks in clipping
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12
Q

How are subarachnoid haemorrhages graded?

A
  • 1-5 dependant on GCS score
  • 5 = GCS 3-6 (1%)
  • 4 = GCS 7-12
  • 3 = GCS 13
  • 2 = GCS 14 (42%)
  • 1 = GCS 15 (mortality rate 77%)
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13
Q

What are the complications of subarachnoid haemorrhage?

A
  • vasospasm causing stroke/death
  • hydrocephalus
  • seizures
  • electrolyte problems (low Na)
  • cardiac rhythm changes (rise troponin)
  • pulmonary oedema, pneumonia
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14
Q

How is vasospasm prevented?

A

Nimodipine (calcium channel antagonist)

Saline (enduce hypervolemia)

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15
Q

What is the treatment of vasospasm?

A
  • bolus iv saline/colloid (help cerebral infusion pressure)
  • hypertensive therapy with inotropes
  • chemical angioplasty with nimodipine
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16
Q

When will someone be screened for aneurysm?

A
  • if two first degree relatives with aneurysms
17
Q

Aneurysms in which cerebral arteries are more likely to rupture?

A
  • Basilar and posterior communicating

- also more likely to rupture if larger

18
Q

What are the independent predictors of aneurysm rupture?

A
  • age
  • hypertension
  • previous SAH
  • aneurysm size
  • location
  • geographical region
19
Q

What is intracerebral haemorrhage?

A
  • bleeding into brain tissue

- high mortality

20
Q

What are the causes of ICH?

A
  • hypertension
  • vascular lesion
  • neoplastic
  • coagulation disorders
  • cerebral venous thrombosis
  • haemorrhagic transformation of ischaemic stroke
  • vasculitis (inflammation of blood vessels)
  • substance abuse
  • amyloid
21
Q

What factors would give you a poor prognosis for ICH?

A
  • poor initial conscious level
  • haemotoma volume >60ml
  • intraventricular haemorrhage on CT
  • increasing age
22
Q

What is a arterio-venous malformation?

A
  • tangled fistulous connection between arteries and veins
  • high pressure arteries going into veins creates weakness in vessel wall
  • can result in bleed
23
Q

What is the treatment for arterio-venous malformation?

A
  • surgery to excise it
  • embolisation using glue
  • stereotactic radiosurgery (to damage vessel wall and obliterate AVM) complications can include bleeding and seizures
24
Q

What is a carotid cavernous fistula?

A
  • dural AV fistula between cavernous part of ICA and cavernous sinus or it’s venous outflow
  • can occur spontaneously or after head trauma
25
Q

What percentage of people with thunderclap headache have subarachnoid headache?

A

10-25 &

Neurology (53 decks)

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