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Neurological System > Cerebral Haemorrhages > Flashcards

Cerebral Haemorrhages Flashcards

1
Q

define an extradural haemorrhage

A

an extradural haemorrhage is a collection of blood between the outer dura mater and inner lining of the skull

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2
Q

what is the most common cause of an extradural haemorrhage?

A

an arterial bleed, which is commonly secondary to a middle meningeal arterial tear and/or vein

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3
Q

events causing an extradural haemorrhage

A

clearly defined head trauma, often in younger patients (e.g. during sport or RTA)

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4
Q

presentation of extradural haemorrhage

A

initial headache and drowsiness that leads to brief loss of consciousness followed by a lucid interval that eventually rapidly deteriorates

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5
Q

additional signs and symptoms of extradural haemorrhage

A

pupil asymmetry due to III CN compression
vomiting
confusion
upgoing plantars

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6
Q

investigations of extradural haemorrhage

A

CT/MRI

HXR

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7
Q

common appearance of an extradural haemorrhage on CT/MRI

A

a lens (lentiform) shaped lesion that is hyperdense that is unilateral and commonly within supraratentorial region

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8
Q

management of extradural haemorrhage

A

urgent decompression
ABCD - high flow O2 and maintain SBP >90mmHg
sit patient up in bed
urgent referral to neurosurgery (1st line)

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9
Q

what procedure is contraindicated in cases of extradural haemorrhage?

A

lumbar puncture!!

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10
Q

define subarachnoid haemorrhage

A

a haemorrhage that bleeds into the subarachnoid space between the pia mater and arachnoid mater

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11
Q

causes of subarachnoid haemorrhage

A

rupture of a cerebral aneurysm (80%) or AV malformation (15%)

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12
Q

risk factors of subarachnoid haemorrhage

A 
hypertension
smoking 
excessive alcohol consumption
FH of subarachnoid haemorrhage
sickle cell anaemia 
cocaine use 
connective tissue disorders
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13
Q

who are the more likely candidates for subarachnoid haemorrhages?

A

black patients
female patients
those aged 45-70

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14
Q

clinical features of subarachnoid haemorrhage

A 
sudden occipital headache (thunderclap) 
neck stiffness 
drowsiness 
photophobia 
vision changes 
neurological/CN signs (e.g. speech changes, weakness, seizures)
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15
Q

investigations of subarachnoid haemorrhage

A

CT head
cerebral angiography once confirmed to detect site of bleed
lumbar puncture

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16
Q

common appearance of subarachnoid haemorrhage on CT

A

star-shaped lesion on CT

17
Q

when are lumbar punctures utilised in SAH and what is the contraindication

A

utilised when CT -ve but still suspect SAH

contraindicated in raised ICP so must be careful

18
Q

describe common lumbar puncture results in SAH

A

raised RBC

xanthochromia - raised bilirubin

19
Q

management of SAH

A

urgent call/help from specialist neurosurgical unit
ABCD if required
haemodynamical stabilisation

20
Q

surgical interventions in SAH

A

done if severe and include coiling or clipping the aneurysm

21
Q

why is nimodipine used in SAH

A

a calcium channel blocker that prevent vasospasm - a common SAH complication

22
Q

define subdural haemorrhage

A

a collection of venous blood between the arachnoid and dura mater

23
Q

causes of subdural haemorrhage

A

caused by rupture of bridging veins between cortex and dura mater

24
Q

patients commonly affected by subdural haemorrhage

A

elderly/alcoholic patients following minor trauma (e.g. a fall)

may also include raised ICP and brain mets

25
Q

risk factors of subdural haemorrhage

A 
advanced age (>65)
bleeding disorders 
anticoagulant therapy
chronic alcohol abuse 
recent trauma
26
Q

clinical features of SDH

A 
headache
nausea/vomiting 
confusion 
diminished eye/verbal/motor response 
late onset focal neurological signs (e.g. unequal pupils + hemiparesis)
27
Q

investigations of SDH

A

CT/MRI head

28
Q

differentials of SDH

A

stroke
dementia
mass lesion

29
Q

common appearance of SDH on scan

A

crescent-shaped hyperdense extra-axial collection over affected hemisphere
causes midline shift of cranial tissue

30
Q

management of SDH

A

ABCDE - start O2 and maintain SBP >90mmHg
irrigation/evacuation/Burr hole craniostomy
craniotomy to relieve high ICP

Neurological System (10 decks)

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