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Neurology > Brain Haemorrhages > Flashcards

Brain Haemorrhages Flashcards

1
Q

How can you classify brain haemorrhages?

A

Extra-axial

Intra-cerebral

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2
Q

What is an extra-axial haemorrhage?

A

When bleeding occurs within the skull but outside the brain

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3
Q

What is an intra-cerebral haemorrhage?

A

Bleeding within the brain itself

Inter-parenchymal

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4
Q

Name the three types of extra-axial haemorrhage?

A

Epi-dural
Sub-dural
Sub-arachnoid

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5
Q

What is an epi-dural haemorrhage?

A

Bleeding in between the dura and the skull bone

Usually the dura is stuck tightly to the skull, in an epi-dural haemorrhage it is peeled away as the blood fills

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6
Q

What causes an epi-dural haemorrhage?

A

Usually a skull fracture that ruptures the middle meningeal artery

Trauma usually

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7
Q

What would an epi-dural haemorrhage look like on a head CT?

A

A classic convex shape on the edge of the brain

This is the haematoma

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8
Q

What is a haematoma?

A

A localised collection of blood outside blood vessels

AKA a bruise

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9
Q

What are the layers of the meninges from inside to out?

A

PAD out

Pia mater
Arachnoid
Dura mater

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10
Q

Clinical features of an epi-dural haemorrhage?

A

Lucid interval: for a period of time (a few hours to a few days) after the injury the person will appear to be fine and functioning normally

After this though they have:

  • increasingly severe headache
  • vomiting
  • confusion
  • unconsciousness, fits, coma
  • death due to coning
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11
Q

What is a lucid interval and why does it occur?

A

For a period of time after an injury that has resulted in an epi-dural haemorrhage, the patient appears to function normally

Because initially the volume of blood in the haematoma is not sufficient to cause any symptoms, as the blood builds up it puts pressure on the brain, affecting its function

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12
Q

What is a sub-dural haemorrhage?

A

Bleeding into the space under the dura

So between the dura and the arachnoid membrane

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13
Q

What happens to the brain inside the skull when you hit your head really hard?

A

When the head is hit it moves rapidly (obviously)

The brain is heavy so it moves backwards and forwards slower than the head does

This causes the brain to crash against the skull, bruising it

It can also cause the tearing of the bridging blood vessels that cross the subdural space

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14
Q

What causes a sub-dural haemorrhage?

A

A head injury

When the brain moves out of sync with the skull the bridging vessels that cross the sub-dural space tear, causing bleeding into the subdural space

Common in elderly who have falls

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15
Q

Which people are more susceptible to sub-dural haemorrhages?

A

Elderly
Alcoholics

Because they have atrophic (shrunken) brains
Their bridging vessels are more likely to tear

They get chronic haematoma

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16
Q

What is chronic haematoma?

A

Occurs in people with small sub-dural haemorrhages

They get signs of dementia and other symptoms as a result
Treatable

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17
Q

Clinical features of sub-dural haemorrhage?

A 
Headache
Fluctuating consciousness
Physical or intellectual slowing
Confusion
Drowsiness

These often develop a long time (months) after injury

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18
Q

How do you treat an epi-dural haemorrhage?

A

Drain the blood

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19
Q

What is coning?

A

Herniation of the brain downwards, compressing the brainstem

Very dangerous as it causes respiratory depression, death

20
Q

Why do the symptoms of a sub-dural haemorrhage take months to manifest?

A

Because at the time of the injury they get a bit of pain, but a clot soon forms and they’re able to go on normally

8-16 weeks later the body tries to break the clot down

The breaking up of the clot releases fibrin
This raises the oncotic pressure of the blood in the haematoma

Water is drawn into the clot, raising the intra-cranial pressure

Compression of brain = symptoms

21
Q

Treatment of a sub-dural haemorrhage?

A

Surgical removal of the haematoma

22
Q

What is a sub-arachnoid haemorrhage?

A

Bleeding into the sub-arachnoid space

Between the arachnoid and the pia mater

23
Q

What causes a sub-arachnoid haemorrhage?

A

Head injury

Spontaneous:

  • berry aneurysms of circle of willis
  • congenital arteriovenous malformations

The circle of willis is in the subarachnoid space

24
Q

Clinical features of a sub-arachnoid haemorrhage?

A

Sudden onset severe ‘thunderclap’ headache
Vomiting
Reduced consciousness
Photophobia

25
Q

What are the risk factors of sub-arachnoid haemorrhage?

A

Smoking + alcohol
Bleeding disorders
Raised BP
Presence of berry aneurysms

26
Q

What does a sub-dural haemorrhage look like on a CT?

A

Whiter region around edge of skull, concave shape

In time the haematoma appears darker and begins to blend in with the brain as the blood clots

27
Q

What does a sub-arachnoid haemorrhage look like on a CT?

A

White, hazy regions

Sub-arachnoid space goes in and out of the brain folds

28
Q

What type of head injury can cause a sub-arachnoid haemorrhage?

A

Base of skull fractures

29
Q

Investigations of sub-arachnoid haemorrhage?

A

CT of head

Lumbar puncture: bloody immediately after haemorrhage, goes yellow later due to bilirubin (breakdown product of blood) xanthochromia

30
Q

Management of sub-arachnoid?

A 
Bed rest
Supportive
Cautious control of blood pressure
IV mannitol
Nimodipine to reduce vasospasm

Treatment of aneurysms: clipping, insertion of wire to clot blood in the aneurysm

31
Q

Why does placing a wire into an aneurysm help prevent it causing a sub-arachnoid haemorrhage?

A

The wire causes the blood in the aneurysm to clot

32
Q

What is an intracerebral haemorrhage?

A

A type of stroke, a haemorrhagic stroke

Bleeding into the brain parenchyma

33
Q

Haemorrhagic strokes are the most common types of stroke.

True or false?

A

False

They only account for about 10%

34
Q

What are some secondary causes of intracerebral haemorrhage?

A

Tumour: metastases
Arterio-venous malformations

Haemorrhagic transformation infarct when a clot infarct leads to haemorrhage

Anti-coagulants

35
Q

What types of primary intracerebral haemorrhage are there?

A

Lobar

Hypertensive

36
Q

Where do hypertensive haemorrhages occur?

A

Basal ganglia
Pons
Cerebellum
Lobes

37
Q

What causes hypertensive haemorrhages?

A

Charcot-Bouchard aneurysms

These arise from deep arteries

They can:

  • rupture
  • cause thrombosis
  • leak
38
Q

What happens when Charcot-Bouchard aneurysms leak?

A

You get micro-bleeds

39
Q

What happens when Charcot-Bouchard aneurysms rupture?

A

Intracerebral haemorrhage

40
Q

What is a lobar intracerebral haemorrhage?

A

A more superficial bleed in the lobes of the brain

41
Q

What causes lobar intracerebral haemorrhages?

A

Many causes

Amyloid protein deposited in abnormal places

Secondary causes

  • tumour
  • structural abnormality
  • etc.
42
Q

Who suffers from intracerebral haemorrhages?

A

The elderly usually

People with secondary causes

43
Q

What complication can arise from a lobar intracerebral haemorrhage?

A

Can bleed into the ventricles of the brain

Dilatation of the ventricles
Pressure on other parts of the brain
= Hydrocephalus

44
Q

Management of intracerebral haemorrhage?

A

Emergency

Stop any anti-coagulants

Surgery to relieve pressure, if blood is draining into ventricles, drain the fluid to reduce pressure

45
Q

What would a intracerebral haemorrhage look like on a CT?

A

White patch at site of bleed

46
Q

You can’t give patients who’ve had a haemorrhage anti-coagulants, so how can you prevent them getting DVT or PE?

A

Compression stockings

47
Q

What is xanthochromia?

A

Yellow colouring of the CSF after a sub-arachnoid haemorrhage

Due to breakdown of blood cells in CSF to bilirubin

Neurology (23 decks)

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