Cerebral Haemorrhage

Question 1

what conditions are linked to cerebral aneurysms

Answer 1

PKD, fibromuscular dysplasia, EDS

Question 2

90% of cerebral aneurysms are in the posterior circulation. T or F

Answer 2

F, 90% in anterior circulation

Question 3

what is the commonest type of cerebral aneurysm

Answer 3

saccular Berry aneurysm

Question 4

how do saccular Berry aneurysms present

Answer 4

SAH
CN palsy (unruptured)

Question 5

an aneurysm of what intracerebral artery often presents with a dilated unresponsive pupil due to a CN III palsy

Answer 5

posterior communicating artery

Question 6

management of cerebral aneurysms

Answer 6

endovascular coil or clipping

Question 7

aneurysms often arise at arterial bifurcations, T or F

Answer 7

T

Question 8

AV malformations can cause steal syndrome, what is the pathology of this

Answer 8

‘steal’ blood causing local ischaemia

Question 9

presentation of a AV malformation

Answer 9

bleed
seizure
HA
neuro deficit

Question 10

diagnostic test for AVMs

Answer 10

catheter angiogram

Question 11

management of AVMs

Answer 11

some kind of surgery

Question 12

gold standard test for cavernous malformations

Answer 12

MRI (not seen on angiogram)

Question 13

a congenital Berry aneurysm bursting causes what type of cerebral haemorrhage

Answer 13

SAH

Question 14

as well as those with Berry aneurysms, what is another risk factor for subarachnoid haemorrhage

Answer 14

alcoholism

Question 15

do subarachnoid haemorrhages always have a precipitant eg. a fall

Answer 15

no

Question 16

in subarachnoid what pathological process occurs secondary to bleeding

Answer 16

chemical meningitis

Question 17

subarachnoid haemorrhage causes a chemical meningitis. how does chemical meningitis present

Answer 17

headache, neck stiffness, photophobia

collectively meningism

Question 18

what is the presentation of subarachnoid haemorrhage due to a berry aneurysm rupture

Answer 18

acute severe thunderclap HA
meningism
N&V
focal signs

Question 19

in SAH, where does the headache typically begin

Answer 19

occiput

Question 20

how does the presentation of a subarachnoid haemorrhage due to berry aneurysm rupture and secondary to trauma differ?

Answer 20

after head trauma can take weeks to develop

aneurysm rupture always acute

Question 21

what is the 1st investigation for subarachnoid haemorrhage

Answer 21

CT brain

Question 22

what is seen on CT in SAH

Answer 22

hyperdense lesion

Question 23

when investigating SAH, if CT is negative or positive, what test should do you next? this is the GOLD STANDARD test for SAH

Answer 23

LP

Question 24

when is LP contraindicated in SAH

Answer 24

neuro defecit or sign of raised ICP

Question 25

what is seen in CSF LP in SAH

Answer 25

blood, xanthochromia

Question 26

what is the definitive Dx of a cerebral aneurysm

Answer 26

cerebral angiography

Question 27

what is the treatment of SAH

Answer 27

supportive + endovascular surgical clip

Question 28

what is the major complication with morbidity in SAH

Answer 28

rebleeding

Question 29

what complication of SAH presents with a worsening headache or decreasing consciousness

Answer 29

hydrocephalus (drain at LP or shunt)

Question 30

what complication of SAH presents after 3-12 days with decreasing consciousness or a focal defecit?

Answer 30

delayed ischaemia

Question 31

what is the general mechanism of delayed ischaemia following SAH

Answer 31

vasospasm

Question 32

what is given as delayed ischaemia prophylaxis following SAH

Answer 32

hydration + nimodipine CCB

Question 33

which type of cerebral haemorrhage is linked to Charcot Bouchard microaneurysms

Answer 33

intracerebral haemorrhage

Question 34

what structure of the brain is often affected by intracerebral haemorrhages

Answer 34

basal ganglia

Question 35

how do intracerebral haemorrhages present

Answer 35

HA, focal deficit, decreasing consciousness

Question 36

investigation for intracerebral haemorrhages

Answer 36

CT

Question 37

which cerebral haemorrhage is associated with falls in the elderly

Answer 37

subdural haemorrhage

Question 38

where is the bleeding in subdural haemorrhage

Answer 38

between dura and arachnoid

Question 39

what is the general pathology of subdural haemorrhage

Answer 39

bridging vein rupture

Question 40

subdural haemorrhages can present acutely or chronically. what is the general acute presentation?

Answer 40

acute loss of consciousness

Question 41

subdural haemorrhages can present acutely or chronically. what is the general chronic presentation?

Answer 41

insidious HA, confusion, incontinent, seizure, gait disturbance over 3-7wk

Question 42

what is seen on CT in acute subdural haemorrhage

Answer 42

hyperdense crescent appearance

Question 43

what is seen on CT in chronic subdural haemorrhage

Answer 43

hypodense crescent

Question 44

are chronic or acute subdural haemorrhages more easily precipitated by minor trauma?

Answer 44

chronic

Question 45

what medication is a risk factor for chronic subdural haemorrhages

Answer 45

aspirin

Question 46

is a neomembrane present in chronic or acute subdural haemorrhages?

Answer 46

chronic

Question 47

where is the bleeding in extradural haemorrhages?

Answer 47

between bone and dura

Question 48

commonest mechanism of extradural haemorrhages?

Answer 48

linear pterion fracture; ruptures middle meningeal artery

Question 49

are extradural haemorrhages more common in younger or old PTx

Answer 49

younger

Question 50

presentation of extradural haemorrhages

Answer 50

head trauma + LOC | lucid interval followed by

Question 51

complication of extradural haemorrhages

Answer 51

uncal herniation

Question 52

what is seen on CT in extradural haemorrhage

Answer 52

hyperdense biconvex lens appearance (LOOK UP PICTURES OF IT, YOU SHOULD BE ABLE TO IDENTIFY IT)

Question 53

management of extradural haemorrhage

Answer 53

sometimes surgery, sometime conservative