Haemorrhage

Question 1

Nimodipine use in SAH

Answer 1

To prevent vasosapsm-induced cerebral ischaemia - optimising cerebral perfusion

Question 2

EVM

GCS parameters

Answer 2

1. Eye movement
2. Verbal response
3. Motor response

Question 3

Colour of SAH CSF

Answer 3

Yellow or pink coloured CSF

Question 4

Why is SAH CSF yellow/pink?

Answer 4

Xanthochromia: increase bilirubin in CSF

Question 5

When to perform LP for SAH?

Answer 5

Inconclusive non-contrast CT >6h after Sx onset
ONLY 12h post Sx onset

Question 6

Confirmed SAH Mx

Answer 6

1st line: Reverse anticoagulant effect
2nd: Nimodipine: Prevent vasospasm to ensure sufficient cerebral perfusion
2nd: Maintain BP <140/80
3rd: CT angiogram head: ?Aneurysm
4th: Endovascular coiling (better prognosis)/Surgically clipping

Question 7

Timeframe for non-contrast CT head

Answer 7

Within 6h: most accurate

Question 8

Suspected SAH Ix

Answer 8

1. Non-contrast CT head

Question 9

Complications of SAH

Answer 9

1. Raised ICP: bleeding increase volume within a closed compartment
2. Cerebral Ischaemia: vasospasm that delay cerebral perfusion

Question 10

Rupture of which artery results in a epidural haematoma (EDH)

Answer 10

middle meningeal artery

MMA

Question 11

Rupture of which artery results in a Subdural haemorrhage (SDH)

Answer 11

Tearing of bridging veins

Question 12

EDH typical Sx

Answer 12

Lucid interval - initail LOC –> followed by temp. recovery –> then rapid neuro decline as the haematoma expands