epilepsy management Flashcards
What is a Subarachnoid haemorrhage?
bleeding into the subarachnoid space
What is the most common cause of subarachnoid haemorrhage
Berry aneurysm
Where is the commonest site of Berry aneurysms?
bifurcations of verses (carotid)
What are the common clinical features of SAH?
sudden onset severe headache collapse vomiting neck pain photophobia
What is benign coital cephalgia?
sudden onset headache while having sex
What is seen on brain CT that indicates blood?
white in the normally black ventricles
What can be seen in a patient with SAH in their CSF?
xanthochromia
How is xanthocromia differentiated from a traumatic tap
multiple bottles
What is the gold standard for diagnosing aneurysms?
cerebral angiography - MR/CT
What causes delayed ischaemic deficit in SAH?
blood vessel vasospasm thus causing ischaemia
What are some complications of SAH?
re-bleeding DID hydrocephalus hyponatraemia seizures
what are the treatment options for SAH?
clipping
coiling
embolisation
When does delayed ischaemic deficit tend to occur?
day 3-12
What medication is given to prevent/treat DID?
nimodipine
What is Triple H therapy?
hypervolaemia
hypertension
haemodilution
dehydration predisposes to cerebral ischaemia
How is hydrocephalus treated?
CSF drainage - LP, EVD, Shunt
What is intracerebral haemorrhage?
bleeding into the brain parenchyma
What is the most common cause of intracerebral haemorrhage?
hypertension
How does ICH present?
headache
focal neurological deficit
reduced consciousness level
How are ICH investigated?
CT
angiography if vascular anomaly suspected
How are ICHs treated?
surgical evacuation of haematoma
treat underlying cause
What is an intraventricular haemorrhage?
rupture of a Subarachnoid or intracerebral bleed into a ventricle
How are AVMs treated?
surgery
embolisation
radiotherapy
conservative
how does embolisation help in AVM treatment
removes some of the problem to make surgery easier
