Cerebral Haemorrhages Flashcards
define an extradural haemorrhage
an extradural haemorrhage is a collection of blood between the outer dura mater and inner lining of the skull
what is the most common cause of an extradural haemorrhage?
an arterial bleed, which is commonly secondary to a middle meningeal arterial tear and/or vein
events causing an extradural haemorrhage
clearly defined head trauma, often in younger patients (e.g. during sport or RTA)
presentation of extradural haemorrhage
initial headache and drowsiness that leads to brief loss of consciousness followed by a lucid interval that eventually rapidly deteriorates
additional signs and symptoms of extradural haemorrhage
pupil asymmetry due to III CN compression
vomiting
confusion
upgoing plantars
investigations of extradural haemorrhage
CT/MRI
HXR
common appearance of an extradural haemorrhage on CT/MRI
a lens (lentiform) shaped lesion that is hyperdense that is unilateral and commonly within supraratentorial region
management of extradural haemorrhage
urgent decompression
ABCD - high flow O2 and maintain SBP >90mmHg
sit patient up in bed
urgent referral to neurosurgery (1st line)
what procedure is contraindicated in cases of extradural haemorrhage?
lumbar puncture!!
define subarachnoid haemorrhage
a haemorrhage that bleeds into the subarachnoid space between the pia mater and arachnoid mater
causes of subarachnoid haemorrhage
rupture of a cerebral aneurysm (80%) or AV malformation (15%)
risk factors of subarachnoid haemorrhage
hypertension smoking excessive alcohol consumption FH of subarachnoid haemorrhage sickle cell anaemia cocaine use connective tissue disorders
who are the more likely candidates for subarachnoid haemorrhages?
black patients
female patients
those aged 45-70
clinical features of subarachnoid haemorrhage
sudden occipital headache (thunderclap) neck stiffness drowsiness photophobia vision changes neurological/CN signs (e.g. speech changes, weakness, seizures)
investigations of subarachnoid haemorrhage
CT head
cerebral angiography once confirmed to detect site of bleed
lumbar puncture
common appearance of subarachnoid haemorrhage on CT
star-shaped lesion on CT
when are lumbar punctures utilised in SAH and what is the contraindication
utilised when CT -ve but still suspect SAH
contraindicated in raised ICP so must be careful
describe common lumbar puncture results in SAH
raised RBC
xanthochromia - raised bilirubin
management of SAH
urgent call/help from specialist neurosurgical unit
ABCD if required
haemodynamical stabilisation
surgical interventions in SAH
done if severe and include coiling or clipping the aneurysm
why is nimodipine used in SAH
a calcium channel blocker that prevent vasospasm - a common SAH complication
define subdural haemorrhage
a collection of venous blood between the arachnoid and dura mater
causes of subdural haemorrhage
caused by rupture of bridging veins between cortex and dura mater
patients commonly affected by subdural haemorrhage
elderly/alcoholic patients following minor trauma (e.g. a fall)
may also include raised ICP and brain mets
risk factors of subdural haemorrhage
advanced age (>65) bleeding disorders anticoagulant therapy chronic alcohol abuse recent trauma
clinical features of SDH
headache nausea/vomiting confusion diminished eye/verbal/motor response late onset focal neurological signs (e.g. unequal pupils + hemiparesis)
investigations of SDH
CT/MRI head
differentials of SDH
stroke
dementia
mass lesion
common appearance of SDH on scan
crescent-shaped hyperdense extra-axial collection over affected hemisphere
causes midline shift of cranial tissue
management of SDH
ABCDE - start O2 and maintain SBP >90mmHg
irrigation/evacuation/Burr hole craniostomy
craniotomy to relieve high ICP
