Haemorrhage

Question 1

Where do intracerebral haemorrhages commonly occur?

Answer 1

basal ganglia

otherwise: thalamus, white matter or cerebellum

Question 2

What are the predisposing factors for intracranial haemorrhages?

Answer 2

open heart surgery
anticoagulants
neoplasms
vasculitis
vascular malformations
aneurysms
hypertension
amyloid angiopathy - common in alzheimers

Question 3

What is the pathology behind intracranial haemorrhages?

Answer 3

shifts and herniation
surrounding oedema
well demarcated intra parenchymal haematoma

Question 4

What commonly causes a subarachnoid haemorrhage?

Answer 4

most commonly due to a berry aneurysm rupture

Question 5

What is the pathology of subarachnoid haemorrhages?

Answer 5

presence of a berry aneurysm and blood in the subarachnoid space
sometimes infarcts of the brain parenchyma and intracerebral haematomas

Question 6

What are the risk factors of subarachnoid haemorrhages?

Answer 6

smoking
hypertension
polycystic kidney disease
connective tissue disease

Question 7

What are the signs of a subarachnoid haemorrhage?

Answer 7

severe headache
vomiting
loss of conciousness
photophobia
retinal or vitreous haemorrhage on fundoscopy
3rd nerve palsy if in the posterior communicating artery

Question 8

What are the investigations and findings of subarachnoid haemorrhages?

Answer 8

CT - hyperdensity in subarachnoid space
CT angiography - definitive investigation
Lumbar puncture - only safe in an alert adult with no neurological deficit - Xanthochromatic CSF staining

Question 9

What commonly causes an extradural haemorrhage?

Answer 9

fracture in the temper-parietal region that involves the middle meningeal artery

Question 10

What does an extradural haemorrhage look like on CT?

Answer 10

lens shape

Question 11

What happens if an extradural haemorrhage is left untreated?

Answer 11

midline shift causing herniation and compression

Question 12

What does an acute subdural harmorrhage look like on CT?

Answer 12

hypERdense crescent shape

Question 13

What does a chronic subdural harmorrhage look like on CT?

Answer 13

hypOdense crescent shape

Question 14

What is the presentation of an acute subdural heamorrhage?

Answer 14

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

Question 15

What do non treated acute subdural haemorrhages turn into?

Answer 15

liquified yellowish membrane

Question 16

What is the presentation of a chronic subdural haemorrhage?

Answer 16

associated with brain atrophy

present as irritable, confused, weakness, seizures, cognitive dysfunction, urinary incontinence, gait abnormalities

Question 17

What is the pathology of chronic subdural haemorrhages?

Answer 17

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

Question 18

What type of blood fills an extradural haemorrhage?

Answer 18

arterial blood

Question 19

What is the presentation of an extradural haemorrhage?

Answer 19

normally have a lucid interval followed by a rapid decline
deteriorating GCS
possible hemiparesis
unilateral fixed and dilated pupil -> apopnea and death

Question 20

What type of blood fills an acute subdural haemorrhage?

Answer 20

venous blood

Question 21

What age of patient normally presents with an extradural haemorrhage?

Answer 21

younger patients

Question 22

What age of patient normally presents with an acute subdural haemorrhage?

Answer 22

elderly

Question 23

What are the complications of a subarachnoid haemorrhage?

Answer 23

rebleeding - 20% within first 14 days
delayed ischaemic deficit - only happens between days 3-12
hydrocephalus
hyponatreamia
seizures

Question 24

How do you treat a delayed ishcaemic deficit?

Answer 24

triple H therapy - cause hypervolaemia, hypertension (give inotropes), haemodilation
can also give Nimodipine

Question 25

What causes an intracerebral haemorrhage?

Answer 25

50% secondary to hypertension

30% due to aneurysm or atriovenous malformation

Question 26

What is an intracerebral haemorrhage?

Answer 26

bleeding into the brain parenchyma

Question 27

What is a hallmark of intracerebral haemorrhages caused by hypertension?

Answer 27

Charcot-bouchard micro aneurysms

Question 28

How do intracerebral haemorrhages present?

Answer 28

headache
focal neurological deficit
decreased concious level

Question 29

How are intracerebral haemorrhages investigated?

Answer 29

CT scan

angiography if suspicion of underlying vascular abnormality

Question 30

What is the treatment of intracerebral haemorrhages?

Answer 30

surgical evacuation of haematoma and treatment of the underlying abnormality

Question 31

What indicates a poor prognosis for an intracerebral haemorrhage?

Answer 31

large basal ganglia or thalamic clot with major focal deficit or deep coma

Question 32

What is and when does an intraventricular haemorrhage occur?

Answer 32

occurs with the rupture of a subarachnoid or intracerebral bleed into a ventricle

Question 33

What is an atriovenous malformation?

Answer 33

abnormal arteriovenous shunts, usually intraparenchymal

Question 34

What do arteriovenous malformations cause?

Answer 34

seizures
headahce
intracerebral, subarachnoid or subdural haemorrhages
steal syndrome - arterial blood from normal vessels is stolen so patients present with weakness