Haemorrhage: Subarachnoid, Extradural Flashcards
Define Subarachnoid haemorrhage?
Bleed that occurs IN THE SUBARACHNOID SPACE, which lies beneath the arachnoid mater, one of the protective layers of the brain.
RFs for Subarachnoid haemorrhage?
Hypertension
Adult polycystic kidney disease
Excessive alcohol consumption
Smoking
Black ethnic origin
Cocaine use
Female
age >50years
FHx
Presentation of Subarachnoid haemorrhage?
- sudden-onsetoccipital headache
- thunderclap headache (extremely painful)
- Neck stiffness
- Photophobia
- Vomiting
- retinal haemorrhages
- Neurological symptoms(e.g., visual changes, dysphasia, focal weakness, seizures and reduced consciousness)
- reduced GCS score
IVx/diagnosis for Subarachnoid haemorrhage?
CT (1ST LINE; within first 24hrs)
- Hyperdensity around the circle of Willis
- Hyperdensity in the subarachnoid space
Lumbar puncture (perform after 12 hrs of symptoms -raised red cell count, Xanthochromia -yellow colour due to bilirubin)
CT angiogram
Management of Subarachnoid haemorrhage?
May require intubation and ventilation
Surgical:
- endovascular coiling or neurosurgical clipping
Medical:
- Nimodipine (CCB) prevents vasospasm
- anti-epileptic drugs -treat seizures
Define Intracranial haemorrhage? How many types -what are they?
Refers to bleeding within the skull.
Four types:
- Extradural haemorrhage
- Subdural haemorrhage
- Intracerebral haemorrhage
- Subarachnoid haemorrhage
Define extradural haemorrhage?
refers to bleeding between the inner surface of the skull and dura mater.
Cause of extradural haemorrhage?
Rupture of themiddle meningeal arteryin thetemporoparietal region.
Severe head trauma
Presentation of extradural haemorrhage?
Initial brief loss of consciousness following the trauma.
A period of regained consciousness and apparent recovery (the lucid interval).
Subsequent deterioration of consciousness and the onset of a headache.
Diagnosis/IVx of extradural haemorrhage?
CT scan
- lentiform or biconvex hyperdense extra-axial collection, most often unilateral and supratentorial
in other words…
Bi-convex “lemon-shaped” mass
Midline shift
Brainstem herniation
Management of extradural haemorrhage?
Depends on the severity of the symptoms and the extent of the mass effect on the brain.
Conservative management (if mild)
Urgent neurosurgical evacuation of the haematoma (severe case)
Define Subdural haemorrhage?
bleeding between the dura mater and arachnoid mater
venous blood
Causes of Subdural haemorrhage?
shearing forces that tear the bridging veins between the cortex and dura mater.
Minor head traumas
Spontaneously in pts with:
- bleeding disorders
- anticoagulant therapy
- chronic alcohol use
- recent trauma
Presentation of Subdural haemorrhage?
Headache
Nausea or vomiting
Confusion
Diminished eye, verbal, or motor response
Focal neurological signs indicating the haematoma site.
The presentation is typically:
- sub-acute (within 3 days to 3 weeks)
or
- chronic (>3 weeks)
Diagnosis/IVx of Subdural haemorrhage?
CT scan
- appearance of clot varies based on its age.
Hyperacute phase (<1hr) = clot appears isodense, cerebral oedema
Acute phase (<3days) = crescent-shaped hyperdense extra-axial collection over the affected hemisphere
Subacute phase (3days-3wks) = clot appears more isodense compared to adjacent cortex
Chronic phase (>3wks) = hypodense
