haemorrhages

Question 1

causes spontaneous SAH

Answer 1

intracranial berry anneuryms (85%) // AV malformation // pituitary apoplexy // infective

Question 2

berry aneurysms associations

Answer 2

hypertension, polycystic kidneys, elhers-danlos, coarction of aorta, cocaine, smoking

Question 3

symptoms SAH

Answer 3

sudden onset worst headache ever // occipital // N+V // meningism

Question 4

what sign is positive O/E SAH

Answer 4

kernigs - cant extend knee when hip is flexed

Question 5

ECG changes SAH

Answer 5

mild changes +/- maybe ST elevation

Question 6

1st line invx SAH

Answer 6

non-contrast CT

Question 7

when would a lumbar puncture be performed in SAH

Answer 7

if CT done 6 hours after presentation + is negative // LP only done after 12 hours of symptoms

Question 8

LP findings SAH

Answer 8

xanthacromia // RBC // raised or normal opening pressure

Question 9

imaging after confirmed SAH diagnosis

Answer 9

CT angio

Question 10

mx SAH

Answer 10

VTE prophylaxis // nimodipine // coil > clipping

Question 11

mx to prevent cerebral vasospasm SAH

Answer 11

oral nimodipine

Question 12

complications SAH

Answer 12

rebleeding // hydrocephalus // vasospasm // hynponatraemia

Question 13

symptoms rebleed SAH, when is it common + mx

Answer 13

first 12 hours –> worsening neuro symptoms –> repeat CT (V deadly)

Question 14

mx hydrocephalus most SAH

Answer 14

drain // long term shunt if needed

Question 15

vasospasm SAH, when is it common + mx

Answer 15

7-14 days // give nifidipine, maintain BP

Question 16

mx hyponatraemia SAH + cause

Answer 16

SIADH // no fluid restriciton, fludrocortisone

Question 17

where does blood collect in subdural haemorrhage + from what vessels

Answer 17

bridging veins in space between dural and arachnoid

Question 18

causes of subdural haemorrhgae

Answer 18

usually trauma, may be minor and patient cannot recall a head knock

Question 19

how long can chronic subdural haematomas be present for

Answer 19

weeks to months

Question 20

who is at risk of chronic subdural haematoma

Answer 20

elderly + alcoholics

Question 21

symptoms subdural haematoma

Answer 21

insidious confusion, sleepy, headache

Question 22

what brain changes are assoc with chronic subdural haematoma

Answer 22

brain atrophy

Question 23

invx + findings acute vs chroni subdural haematomya

Answer 23

CT acute = bright crescent shape, possible midline herniation // CT chronic = dark cresent, atrophy

Question 24

mx subdural haematoma

Answer 24

1 = burr holes // 2 = craniotomy

Question 25

where does blood collect extradural haematoma

Answer 25

skull and dura

Question 26

which vessel is damaged in extradural haematoma

Answer 26

middle meningeal

Question 27

symptoms extradural haemorrhage

Answer 27

brief LOC –> lucid period –> neuro signs + confusion + fixed dilated pupils

Question 28

imaging findings extradural haematoma

Answer 28

CT biconcave bright area // limited by suture lines of skull

Question 29

mx extradural haematoma

Answer 29

craniotamy + evacuation of blood

Question 30

what do intracerebral heamorrhages cause

Answer 30

strokes