Haemorrhage Flashcards
risk factors for haemorrhage (6)
congenital malformation hypertension systemic anti coagulation (eg on warfarin) trauma amyloid deposits vasculitis
where are extradural haemorrhages
between the bone and dura
aetiology of extradural haemorrhages
head trauma (sporting injuries)
which part of the skull is usually fractured in extra dural haemorrhages
which vessel does this cause to haemorrhage
pterion
middle meningeal artery
how does extradural haemorrhage present after trauma
loss of consciousness
headache
vomiting
what investigation should you do after any head trauma
CT
what shape does a extradural haemorrhage look like on CT
convex lens
what can happen to the rest of the brain after an extradural haemorrhage (seen on CT)
midline shift/herniation
management of extradural haemorrhage
SUGRERY asap
where is the bleed in a subdural haemorrhage
between the dura and arachnoid mater
which vessels are rupture in a subdural haemorrhage
cerebral bridging veins
who presents with subdural haemorrhages
elderly/alcoholics after falls
presentation of subdural haemorrhage
slow/chronic onset headache confusion urinary incontinence weakness
what shape does a subdural haemorrhage look like on CT
crescent shaped (moon)
what colour is fresh blood on brain CT
white
management of subdural haemorhrage
surgery asap
where is a subarachnoid haemorrhage at
between arachnoid and pia mater
3 main causes of subarachnoid haemorrhage
severe trauma (worse than extradural haemorrhage) circle of willis aneurysm eg berry aneurysm (complication of PKD) congenital aneurysm (AVM - arteriovenous malformation)
which vessel is affected in a berry aneurysm
circle of willis
which part of the circle of willis is most susceptible to aneurysms
bifurcation of internal carotid
why does subarachoid haemorrhage present like meningitis
blood aggravates the dura (like meningitis)
presentation of subarachnoid haemorrhage
thunderclap headache for 1 hour - worst headache ever neck stiffness photophobia vomiting oss of consciousness
what is sudden onset headache during sex (just before climax) called
what should be your top differential if you suspect this
benign coital cephalgia
SUBARACHNOID HAEMORRHAGE!
when doesn’t CT pick up a haemorrhage
if not acute presentation
blood has absorbed into brain tissue
investigation for subarachnoid haemorrhage (3)
CT - looking for white around circle of willis etc
lumbar puncture
CT angiography
what would you expect to see in lumbar puncture sample if subarachnoid haemorrhage
xanthochromic (yellow CSF)
what is it called when there is fresh blood in the CSF sample from lumbar puncture
traumatic tap (just pinched a blood vessel when doing LP)
which investigation is GOLD standard for subarachnoid haemorrhage
why isn’t CT
lumbar puncture
bc CT only picks up fresh haemorhrage
what is the DIAGNOSTIC investigation done for subarachnoid haemorrhages
CT angiography
to find the source of bleeding
management of subarachnoid haemorrhage
why don’t you need to remove the blood
symptomatic - bed rest, hydration
curative - surgery (coil or clip)
blood is reabsorbed into CSF itself, only need to stop the bleeding don’t need to get rid of blood
patient had subarachnoid bleed 1 week ago
now has altered consciousness
what complication does he have
vasospasm = delayed ischemia
what happens if you don’t coil/clip the bleeding artery
rebleed
after subarachnoid haemorrhage, blood is reabsorbed into CSF
how does this affect the patient
how do you treat this
transient headache
nothing, just warn them it will happen
brain herniation through foramen magnum causes…
cushings triad
- low HR, irregular RR, extreme hypertension
FATAL
how many people die on the spot of subarachnoid haemorrhage
how mnay people die after a months of subarachnoid haemorrhage
10%
50%
what is another name for an intracerebral hameorhrage
hemorrhagic stroke (See stroke flashcards)
are arteriovenous malformations (AVM) congenital or acquired
congenital
why are AVM serious
can haemorrhage (intracerebral, subarachnoid or subdural)
treatment of AVM
surgery to remove
embolization/coil to stop bleed
investigation for AVM
catheter angiography - see a tangle of vessels
‘popcorn like’ appearance on brain MRI
cause of haemorrhage
cavernous malformation
which type of circle of willis aneurysm is associated with polycyctic kidney disease (PKD)
berry aneurysm
apart from PKD, what other condition is associated with brain aneurysms
ehlers danlos
bc aneurysms are a problem with the elasticity of blood vessel membrane
