Haemorrhages

Question 1

what is a subarachnoid haemorrhage?

Answer 1

spontaneous bleeding into the subarachnoid space

Question 2

what are berry aneurysms?

Answer 2

occur at junction of posterior communicating with the internal carotid

Question 3

what other conditions are most commonly associated with berry aneurysms?

Answer 3

polycystic kidneys
co-arctation of the aorta
ehler’s danols syndrome

Question 4

what symptoms may the patient experienced before the subarachnoid haemorrhage?

Answer 4

sentinel headache

- warning lake from the offending aneurysm

Question 5

what symptoms are experienced in those who have a subarachnoid haemorrhage?

Answer 5

neck stiffness
kernigs sign - thigh flexed at the hip + knee at 90 degrees + subsequent extension of the knee is painful
sudden devastating occipital headache - being licked in the head

Question 6

what is the cause of subarachnoid haemorrhages?

Answer 6

rupture of saccular aneurysms

Question 7

how is subarachnoid haemorrhages diagnosed?

Answer 7

CT

LP

Question 8

what is seen on LP in a subarachnoid haemorrhage?

Answer 8

bloody early on - becomes xanthochromic (yellow) on standing

Question 9

how is subarachnoid haemorrhages treated?

Answer 9

neurosurgery immediately

Ca2+ antagonist- nimodipine - reduces chance of vasospasm

Question 10

what is a subdural haemorrhage?

Answer 10

haemorrhage caused by bleeding from bridging veins between cortex and venous sinuses

Question 11

what does a subdural haemorrhage result in?

Answer 11

accumulating haematoma between the dura and arachnid

Question 12

what are the most causes of subdural haemorrhage?

Answer 12

trauma
alcoholics
decreased ICP

Question 13

what are the symptoms experienced by those with a subdural haemorrhage?

Answer 13

fluctuating levels of consciousness ± insidious onset
intellectual slowing
localising neurological symptoms - unequal pupils (occurring long after injury)

Question 14

what is the investigations for a subdural haemorrhage?

Answer 14

CT/MRI

Question 15

what does a CT show in a subdural haemorrhage?

Answer 15

crescent shaped collection of blood over 1 hemisphere

Question 16

what is the treatment for a subdural haemorrhage?

Answer 16

irrigation/evacuation

craniotomy

Question 17

what is the possible complications of a subdural haemorrhage?

Answer 17

raise in ICP –> shifting in midline away from the clot

tentorial herniation and coning

Question 18

what is a extradural haemorrhage?

Answer 18

fractures pterion causing lacerations of the middle meningeal artery and vein

Question 19

where does blood accumulate in an extradural haemorrhage?

Answer 19

between blood and bone

Question 20

how does an extradural haemorrhage present as?

Answer 20

lucid interval pattern - increasing severity of headache + confusion followed by hemiparesis with brisk reflects + up going planar

Question 21

what happens when bleeding continues in an extra dural haemorrhage?

Answer 21

ipsilateral pupil dilates
coma
bilateral limb weakness

Question 22

what does a CT show in a extradural haemorrhage?

Answer 22

clot more round shaped bc tough dural attachments to the skull keep it more localised

Question 23

how is an extradural haemorrhage treated?

Answer 23

stabilise + transfer urgently to neurosurgery unit