Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurosurgery > Brain Haemorrhage > Flashcards

Brain Haemorrhage Flashcards

1
Q

What is a subarachnoid haemorrhage

A

When an aneurysm bursts and blood fills the subarachnoid space. Space between the dura and Pia matter.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why are subarachnoid haemorrhages so important to diagnose

A

The risk of the aneurysm bursting again within the next couple of weeks is high if the aneurysm is not secured or blocked off. Most people can not survive two aneurysm bleeds.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is an aneurysm

A

A local dilation of a blood vessel wall. Has a neck, body and fungus.
Neck: where it comes off the blood vessel.
Body: main bulk of the aneurysm
Fundus : dome of the aneurysm where it usually bursts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why do aneurysms usually burst at the fundus

A

Because the fundus is only composed of tunica adventitia and intima , No media of internal elastic lamina. thinnest part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where do aneurysms tend to develop

A

At the branching of blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When is an aneurysm considered wide neck

A

if neck is grater than 4 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the important findings in a clinical history of subarachnoid haemorrhage

A 
1- Thunderclap headache ( comes on suddenly and hits peak ) 
2- vomiting  
3- neck stiffness 
4- photophobia 
5- seizure and loss of consciousness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What tests are done if subarachnoid haemorrhage is suspected and what are the important clinical examination findings

A

1- GCS : for loss of consciousness
2- Pupils : bilateral fixed dilated pupils means very high ICP / 3rd CN aneurysm
3- Cranial nerves esp fundoscopy to look for papilodema or vitreous bleed in eye
4- Peripheral nervous system incase haemorrhage has caused weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What aneurysm can press on cranial nerve 3 and how will it present

A

Posterior communicating artery aneurysm can press on the 3rd cranial nerve , resulting in a dilated pupil on that side / oculomotor palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the risk factors for subarachnoid haemorrhages

A

1- Strong family history ( 2+ relatives, will offer yearly screening )
2- smoking
3- hypertension
4- alcohol excess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the first imaging done for a suspected subarachnoid haemorrhaged why is it vital to do it right away

A

CT Brian. sensitivity of the aneurysm drops every 6 hours of waiting , since blood will be reabsorbed and washed off by the CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the percentage of sensitivity if patient get’s CT brain for subarachnoid haemorrhage a week after symptoms

A

Less than 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Explain how different things present ( colour wise ) on a CT scan

A

Bone : White
CSF : black
Blood : whitish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the next step if a patient coming in with suspected subarachnoid haemorrhage but CT brain scan is normal and what are it’s requirements

A

Lumber puncture. More sensitive test than CT.

Have to wait at least 12 hours after headache. CSF then assessed via spectrophotometry.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does a lumber puncture look for if subarachnoid haemorrhage is suspected

A

Bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is bilirubin found in subarachnoid haemorrhages

A

1- RBC is borked down and release HB

2- HB is metabolized to oxyHB and bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How to preform a lumber puncture

A

1- Patient is positioned on their side , curled up in the fetal position.
2- aiming for interspinal space between L4 & L5 , landmark is iliac crest at L4
3- aim for umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why are lumber punctures does between L4& L5

A

Because there’s no spinal cord there so it is safe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What will happen to CSF lumber puncture sample if it is not spun asap

A

There will be a big surge in oxyhemoglobin that could mask other findings like the bilirubin shoulder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the contraindication to a lumber puncture and why

A

1- patients with focal neurological defect or abnormal conscious level : if patient has tutor or hematoma LP will draw CSF downwards which will make the brain sink downwards and put pressure eon brainstem
2- Coagulation disorders
3- infection at puncture site
4- it’s been more than 2 weeks since headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the next step if the CT Brian for SAH is positive

A

Have a CT angiogram and if positive then schedule with neurosurgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the next step if CT brain for SAH is negative but it has been over 2 weeks

A

Have to discuss with neurosurgery the next step

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the next step if the LP is positive for SAH

A

CT angiogram or catheter angiogram if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the possible treatment options for a SAH

A

1- Coiling

2- Clipping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Explain the process of coiling and the risks

A

Done by : interventional neuroradiologist
How: endovascularly , puncture the radial or femoral artery and pass catheter into the aneurysm which deploys detachable platinum coil.

Risk of defect due to thromboembolism , risk of stroke is less than 5

26
Q

What is the follow up process with SAH patient having undergone coiling

A

The could be regrowth due to loose packing of coil , so patients are followed up with serial scans

27
Q

Explain the process of clipping , it’s difficulties and risks

A

Done by : neurosurgeons

How: have to open the scalp, performing a craniotomy and putting a clip on the aneurysm

Difficulties : brain is swollen

Risks: Death ( 1-2 ) , Stroke ( 10 ) , bleeding, seizure, infection ( meningitis )

28
Q

Which SAH treatment option is preferred now

A

Coiling

29
Q

The grading for SAH is based on what ( explain each grade )

A 
The Glasgow Coma Score 
Grade 1 : GSC 15 
Grade 2: DSc 14 
Grade 3 : GCS 13 
Grade 4: GSC 7-12 
Grade 5: GSC 3-6
30
Q

When could coiling not be possible

A

If coiling the aneurysm would occlude a vessel

31
Q

Why would a post clipping surgery CT brain show a wide circle figure in ventricles

A

A drain put in to reduce brain swelling , to make surgery easier

32
Q

If a patient’s CT brain shows a part of their brain darker than the rest what is assumed

A

decreased blood flow, stroke

33
Q

What is a major complication and cause of morbidity in 30% of patients with SAH

A

Vasospasm that causes stroke / death. more likely if patient had more bleeding due to aneurysm

34
Q

How are vasospasm prevented

A

1- Nimodipine reduces risk of stroke : has to be given within 96hrs of SAH
2- Hypervolemia : 125 normal saline to keep blood volume high

35
Q

What will happen if a SAH patient is dehydrated

A

They will have a stroke

36
Q

What are the rescue measures if SAH patient gets a vasospasm

A

1- Bolus of IV saline
2- Hypertensive therapy to push BP and reduce stroke risk : noradrenaline
3- Chemical angioplasty : nimodipine is injected directly into cranial vessels

37
Q

What is a decompressive craniotomy

A

Surgery done to accommodate brain swelling and reduce ICP

38
Q

Complications of SAH

A

1- Hydrocephalus
2- Seizures
3- Electrolyte problems : low sodium
4- ECG/cardiac rhythm changes : due to sympathetic discharge cause arrhythmias
5- Pulmonary oedema / pneumonia : sympathetic discharge cause pulmonary vasoconstriction

39
Q

What is hydrocephalus

A

build up of fluid in brain

40
Q

What are the outcomes for SAH

A
  • Fatality : 51%

- survivors : 1/3 are dependant

41
Q

The risk of aneurysm rupturing increased when

A

1- If aneurysm is more posteriorly located , in basilar artery / posterior communicating artery
2- bigger the aneurysm
3- previous SAH
4- age
5- Hypertension
6- Geographical location : more common in Japan and Finland

42
Q

What are intracerebral haemorrhages

A

Bleeding into the Brian tissue itself. High mortality

43
Q

What is probably the underlying reason of a patient <45 years getting a ICH

A

underlying Vascular lesion

44
Q

List the causes of ICH ( 9 )

A 
1- Hypertension 
2- Vascular lesion : aneurysm rupture / arteriovenous malformation 
3- tumor 
4- coagulation disorders 
5- thrombosis 
6- Bleeding into Ischaemic stroke 
7- vasculitis 
8- substance abuse 
9- amyloid
45
Q

What is AVM

A

Arteriovenous malformation where there Is abnormal connection between blood vessels. Tangled fistulous connecting arteries and veins, so high pressure blood from artery going into vein = weakness in vessel wall = can rupture and bleed

46
Q

What factors can give poor prognosis for ICH patient

A

1- hematoma
2- blood in ventricles
3- increasing age
4- poor conscious level

47
Q

What would give incentive for neurosurgery on ICH patient

A

Young patent and borderline conscious level

48
Q

Why are some ICH not operated on

A

Deep into the brain and have to go through a lot of normal tissue , risky and trial shows that sometimes there isn’t much benefit

49
Q

What are the possible options for AVM treatment

A

1- Surgery
2- Embolisation : glue it
3- Stereotactic radio surgery

50
Q

What is Stereotactic radio surgery

A

Radiation will damage blood vessel wall and obliterate AVM by occluding vessel lumen

51
Q

What are the complications of stereotactic radosurgery

A

1- radiation necrosis
2- bleeding
3- seizure

52
Q

If patient has lost visual acuity ( CN2 ) and lost eye movements ( CN 3, 4 ,5 ). Where could the problem be

A

Cavernous sinus , all of these nerves meet

53
Q

What is a Carotid Cavernous Fistula

A

Fistula between the internal carotid artery cavernous part and the cavernous sinus or its venous outflow. Increases cavernous sinus pressure. Could be spontaneous or due to trauma

54
Q

What are the signs of Carotid cavernous fistula

A 
1- orbital bruit 
2- exophthalmos , ocular pulsation , chemises 
3- pulsatile tinnitus 
4- visual loss 
5- headache 
6- extra ocular muscle palsies
55
Q

What is the treatment for Carotid cavernous fistulas

A

Endovascular treatment

56
Q

What percentage of thunderclap headache patients have SAH

A

10-25%

57
Q

What are differential diagnosis for thunderclap headache

A 
1- Bening thunderclap / headache 
2- ischaemic stroke /. venous sinus thrombosis 
3- pituitary apoplexy 
4- carotid/vertebrobasilar dissection 
5- sinusitis/meningitis / brain abscess 
6- brain tumour/ hydrocephalus
58
Q

What is the most important diagnosis to exclude form thunderclap headache

A

SAH

59
Q

What is the prevalence of ICH

A

3%

60
Q

Why should aneurysms be treated quickly

A

to prevent risk of rebleed

Neurosurgery (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions