Haemorrhage Flashcards
Where do intracerebral haemorrhages commonly occur?
basal ganglia
otherwise: thalamus, white matter or cerebellum
What are the predisposing factors for intracranial haemorrhages?
open heart surgery anticoagulants neoplasms vasculitis vascular malformations aneurysms hypertension amyloid angiopathy - common in alzheimers
What is the pathology behind intracranial haemorrhages?
shifts and herniation
surrounding oedema
well demarcated intra parenchymal haematoma
What commonly causes a subarachnoid haemorrhage?
most commonly due to a berry aneurysm rupture
What is the pathology of subarachnoid haemorrhages?
presence of a berry aneurysm and blood in the subarachnoid space
sometimes infarcts of the brain parenchyma and intracerebral haematomas
What are the risk factors of subarachnoid haemorrhages?
smoking
hypertension
polycystic kidney disease
connective tissue disease
What are the signs of a subarachnoid haemorrhage?
severe headache
vomiting
loss of conciousness
photophobia
retinal or vitreous haemorrhage on fundoscopy
3rd nerve palsy if in the posterior communicating artery
What are the investigations and findings of subarachnoid haemorrhages?
CT - hyperdensity in subarachnoid space
CT angiography - definitive investigation
Lumbar puncture - only safe in an alert adult with no neurological deficit - Xanthochromatic CSF staining
What commonly causes an extradural haemorrhage?
fracture in the temper-parietal region that involves the middle meningeal artery
What does an extradural haemorrhage look like on CT?
lens shape
What happens if an extradural haemorrhage is left untreated?
midline shift causing herniation and compression
What does an acute subdural harmorrhage look like on CT?
hypERdense crescent shape
What does a chronic subdural harmorrhage look like on CT?
hypOdense crescent shape
What is the presentation of an acute subdural heamorrhage?
acute deteriorating conciousness
history of trauma
cerebral flow and blood volume is reduced
brain shrinks - bridging veins from brain to skull are ruptured
gyral columns are preserved
columns swell on the side of the haematoma
What do non treated acute subdural haemorrhages turn into?
liquified yellowish membrane
What is the presentation of a chronic subdural haemorrhage?
associated with brain atrophy
present as irritable, confused, weakness, seizures, cognitive dysfunction, urinary incontinence, gait abnormalities
What is the pathology of chronic subdural haemorrhages?
liquified blood/yellow tinged fluid seperated from inner surface of dura mater and underlying brain by neomembrane
brain atrophy
increased ICP and decreased perfusion
due to accumulation of blood in subdural space and osmotic gradient that draws more fluid into the space
What type of blood fills an extradural haemorrhage?
arterial blood
What is the presentation of an extradural haemorrhage?
normally have a lucid interval followed by a rapid decline
deteriorating GCS
possible hemiparesis
unilateral fixed and dilated pupil -> apopnea and death
What type of blood fills an acute subdural haemorrhage?
venous blood
What age of patient normally presents with an extradural haemorrhage?
younger patients
What age of patient normally presents with an acute subdural haemorrhage?
elderly
What are the complications of a subarachnoid haemorrhage?
rebleeding - 20% within first 14 days delayed ischaemic deficit - only happens between days 3-12 hydrocephalus hyponatreamia seizures
How do you treat a delayed ishcaemic deficit?
triple H therapy - cause hypervolaemia, hypertension (give inotropes), haemodilation
can also give Nimodipine
