Haemorrhage Flashcards
What is the clinical presentation for a subarachnoid haemorrhage?
1) Sudden + severe occipital headache (thunderclap)
2) Vomitting
3) Neck stiffness (Kernig’s sign after 6 hours)
4) ALOC (drowsiness, collapse, seizures, coma)
5) Papilloedema
6) Focal neurology
7) Retinal bleed
8) Sentinel Headache
What investigations would you do for an SAH? What would you see?
1) CT Scan - star-shaped lesion
2) LP - If CT is normal but SAH is suspected, bloody early, yellow (xanthochromic several hours after)
How would you treat SAH?
1) Medical emergency - refer to neurosurgery ASAP.
2) Maintain cerebral perfusion - keep hydrated + dexamethasone to decrease cerebral oedema.
3) Nimodipine (CCB) - reduce vasospasm.
4) Surgery - Endovascular coiling or surgical clipping.
Complications of SAH?
1) Rebleeding
2) Cerebral Ischaemia (due to vasospasm)
3) Hyponatraemia
4) Hydrocephalus
What are 5 risk factors for Subdural haematoma?
1) Traumatic Head Injury
2) Increasing age (cerebral atrophy makes bridging veins vulnerable)
3) Anticoagulant medication
4) Alcoholism (Cerebral atrophy)
5) Physical abuse in infant
What are the signs and symptoms for a Subdural Haematoma?
If Acute: 1) Fluctuating levels of consciousness 2) Raised ICP with headache, vomitting, nausea, raised BP) 3) Seizures 4) Confusion 5) Focal signs - hemiparesis/unequal pupils If Chronic: 1) Cognitive Decline 2) Personality change
What investigations would you do for a SDH?
1) CT/MRI - shows hyper dense crescent shaped mass over 1 hemisphere. Differentiates from EDH.
(Will eventually become hypodense as clot ages due to protein degradation)
Treatment for SDH?
1) Assess and manage ABC’s + prioritise CT.
2) Refer to neurosurgeons - Burr twist drill + burr hole craniotomy.
3) IV Mannitol to reduce ICP
4) Address cause of trauma - fall due to cataract etc.
What causes an extradural haemorrhage?
Trauma to the temple or parietal bone causing a bone fracture and laceration of the middle meningeal artery.
What is the clinical presentation for an EDH?
1) Brief post-traumatic loss of consciousness
2) Lucid interval for several hours or days followed by deteriorating consciousness.
3) Rapid increase in ICP - nausea, vomitting headache
4) Seizures and confusion
5) Hemiparesis with brisk reflexes
7) Transtentorial coning - ipsilateral dilated pupil, tetraplegia, respiratory arrest due to brainstem compression
What investigations are done for a suspected EDH?
1) CT - gold standard showing hyper dense biconvex/lens shape adjacent to skull
2) X-ray shows fracture line
3) LP is contraindicated
How do you treat an EDH?
1) Medical emergency - assess and stabilise with ABCDE.
2) Refer to Neurosurgery for clot evacuation and ligation of bleeding vessel.
3) IV Mannitol to decrease ICP