Cerebral Haemorrhage Flashcards
what conditions are linked to cerebral aneurysms
PKD, fibromuscular dysplasia, EDS
90% of cerebral aneurysms are in the posterior circulation. T or F
F, 90% in anterior circulation
what is the commonest type of cerebral aneurysm
saccular Berry aneurysm
how do saccular Berry aneurysms present
SAH CN palsy (unruptured)
an aneurysm of what intracerebral artery often presents with a dilated unresponsive pupil due to a CN III palsy
posterior communicating artery
management of cerebral aneurysms
endovascular coil or clipping
aneurysms often arise at arterial bifurcations, T or F
T
AV malformations can cause steal syndrome, what is the pathology of this
‘steal’ blood causing local ischaemia
presentation of a AV malformation
bleed
seizure
HA
neuro deficit
diagnostic test for AVMs
catheter angiogram
management of AVMs
some kind of surgery
gold standard test for cavernous malformations
MRI (not seen on angiogram)
a congenital Berry aneurysm bursting causes what type of cerebral haemorrhage
SAH
as well as those with Berry aneurysms, what is another risk factor for subarachnoid haemorrhage
alcoholism
do subarachnoid haemorrhages always have a precipitant eg. a fall
no
in subarachnoid what pathological process occurs secondary to bleeding
chemical meningitis
subarachnoid haemorrhage causes a chemical meningitis. how does chemical meningitis present
headache, neck stiffness, photophobia
collectively meningism
what is the presentation of subarachnoid haemorrhage due to a berry aneurysm rupture
acute severe thunderclap HA
meningism
N&V
focal signs
in SAH, where does the headache typically begin
occiput
how does the presentation of a subarachnoid haemorrhage due to berry aneurysm rupture and secondary to trauma differ?
after head trauma can take weeks to develop
aneurysm rupture always acute
what is the 1st investigation for subarachnoid haemorrhage
CT brain
what is seen on CT in SAH
hyperdense lesion
when investigating SAH, if CT is negative or positive, what test should do you next? this is the GOLD STANDARD test for SAH
LP
when is LP contraindicated in SAH
neuro defecit or sign of raised ICP
what is seen in CSF LP in SAH
blood, xanthochromia
what is the definitive Dx of a cerebral aneurysm
cerebral angiography
what is the treatment of SAH
supportive + endovascular surgical clip
what is the major complication with morbidity in SAH
rebleeding
what complication of SAH presents with a worsening headache or decreasing consciousness
hydrocephalus (drain at LP or shunt)
what complication of SAH presents after 3-12 days with decreasing consciousness or a focal defecit?
delayed ischaemia
what is the general mechanism of delayed ischaemia following SAH
vasospasm
what is given as delayed ischaemia prophylaxis following SAH
hydration + nimodipine CCB
which type of cerebral haemorrhage is linked to Charcot Bouchard microaneurysms
intracerebral haemorrhage
what structure of the brain is often affected by intracerebral haemorrhages
basal ganglia
how do intracerebral haemorrhages present
HA, focal deficit, decreasing consciousness
investigation for intracerebral haemorrhages
CT
which cerebral haemorrhage is associated with falls in the elderly
subdural haemorrhage
where is the bleeding in subdural haemorrhage
between dura and arachnoid
what is the general pathology of subdural haemorrhage
bridging vein rupture
subdural haemorrhages can present acutely or chronically. what is the general acute presentation?
acute loss of consciousness
subdural haemorrhages can present acutely or chronically. what is the general chronic presentation?
insidious HA, confusion, incontinent, seizure, gait disturbance
over 3-7wk
what is seen on CT in acute subdural haemorrhage
hyperdense crescent appearance
what is seen on CT in chronic subdural haemorrhage
hypodense crescent
are chronic or acute subdural haemorrhages more easily precipitated by minor trauma?
chronic
what medication is a risk factor for chronic subdural haemorrhages
aspirin
is a neomembrane present in chronic or acute subdural haemorrhages?
chronic
where is the bleeding in extradural haemorrhages?
between bone and dura
commonest mechanism of extradural haemorrhages?
linear pterion fracture; ruptures middle meningeal artery
are extradural haemorrhages more common in younger or old PTx
younger
presentation of extradural haemorrhages
head trauma + LOC
lucid interval followed by
complication of extradural haemorrhages
uncal herniation
what is seen on CT in extradural haemorrhage
hyperdense biconvex lens appearance (LOOK UP PICTURES OF IT, YOU SHOULD BE ABLE TO IDENTIFY IT)
management of extradural haemorrhage
sometimes surgery, sometime conservative
