Haemorrhage

Question 1

major risk factors intracerebral haemorrhage

Answer 1

HTN
XS alcohol
inc age
smoking

Question 2

what do the risk factors for haemorrhage cause

Answer 2

secondary vascular changes such as small vessel disease & arterial aneurysms which may eventually rupture and bleed

Question 3

intracerebral haemorrhage presentation

Answer 3

sudden loss of consciousness and stroke with a severe headache

Question 4

diagnosis intracerebral haemorrhage

Answer 4

brain imaging with CT or MRI

Question 5

what should be stopped in intracerebral haemorrhage

Answer 5

anticoagulants

effects should be reversed with a prothrombin complex concentrate

Question 6

which pts w intracerebral haemorrhage should be immediately referred for neurosurgical evaluation

Answer 6

pts w a large intracerebral haematoma causing deepening coma or brainstem compression
pts w a cerebellar bleed causing hydrocephalus as a result of obstruction of the drainage pathways for CSF

Question 7

what does subarachnoid haemorrhage mean

Answer 7

arterial bleeding into the subarachnoid space

Question 8

subarachnoid haemorrhage most common cause

Answer 8

rupture of saccular (berry) aneurysms

Question 9

subarachnoid haemorrhage clin features

Answer 9

sudden onset of severe headache
nausea and vomitting
maybe: neck stiff / kernigs sign
some have a small warning bleed / headache a few days before

Question 10

investigation subarachnoid haemorrhage

Answer 10

CT ASAP
lumbar puncture if strong clinical suspicion of SAH but CT norm
MR angiography to identify source of bleeding in pts for surgery

Question 11

what would you find in lumbar puncture if SAH

Answer 11

Inc in pigments (bilirubin / oxyhaemoglobin released from lysis and phagocytosis of RBCs)

Question 12

management subarachnoid haemorrhage

Answer 12

initial = bed rest & supportive measures w control of HTN
Nimodipine, a CCB, give to decrease cerebral artery spasm
0.9% saline to maintain normal sodium conc
All pts discussed w neurosurgeon - obliteration of aneurysm by surgical clipping

Question 13

prognosis SAH

Answer 13

50% die suddenly or soon after

further 10-20% in the in early weeks in hosp

Question 14

what has most prognostic significance in SAH

Answer 14

GCS on admission

pts w score >12 = good outcome

Question 15

subdural haematoma

Answer 15

accumulation of blood in the subdural space following the rupture of a vein

Question 16

causes subdural haematoma

Answer 16

minor head injury

latent interval between injury and symptoms may be weeks or months

Question 17

clin features subdural haematoma

Answer 17

headache, drowsiness and confusion

Question 18

diagnosis and rx subdural haematoma

Answer 18

CT

surgical removal

Question 19

extradural haemorrhage causes

Answer 19

caused by injuries that fracture the temporal bone and rupture the underlying middle meningeal artery

Question 20

clinical presentation extradural haemorrhage

Answer 20

head injury
brief unconsciousness
interval of recovery
rapid deterioration with focal neurological signs and deterioration in conscious level is surgical drainage is not immediately carried out