Haemorrhages Flashcards
what is a subarachnoid haemorrhage?
spontaneous bleeding into the subarachnoid space
what are berry aneurysms?
occur at junction of posterior communicating with the internal carotid
what other conditions are most commonly associated with berry aneurysms?
polycystic kidneys
co-arctation of the aorta
ehler’s danols syndrome
what symptoms may the patient experienced before the subarachnoid haemorrhage?
sentinel headache
- warning lake from the offending aneurysm
what symptoms are experienced in those who have a subarachnoid haemorrhage?
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
what is the cause of subarachnoid haemorrhages?
rupture of saccular aneurysms
how is subarachnoid haemorrhages diagnosed?
CT
LP
what is seen on LP in a subarachnoid haemorrhage?
bloody early on - becomes xanthochromic (yellow) on standing
how is subarachnoid haemorrhages treated?
neurosurgery immediately
Ca2+ antagonist- nimodipine - reduces chance of vasospasm
what is a subdural haemorrhage?
haemorrhage caused by bleeding from bridging veins between cortex and venous sinuses
what does a subdural haemorrhage result in?
accumulating haematoma between the dura and arachnid
what are the most causes of subdural haemorrhage?
trauma
alcoholics
decreased ICP
what are the symptoms experienced by those with a subdural haemorrhage?
fluctuating levels of consciousness ± insidious onset
intellectual slowing
localising neurological symptoms - unequal pupils (occurring long after injury)
what is the investigations for a subdural haemorrhage?
CT/MRI
what does a CT show in a subdural haemorrhage?
crescent shaped collection of blood over 1 hemisphere
what is the treatment for a subdural haemorrhage?
irrigation/evacuation
craniotomy
what is the possible complications of a subdural haemorrhage?
raise in ICP –> shifting in midline away from the clot
tentorial herniation and coning
what is a extradural haemorrhage?
fractures pterion causing lacerations of the middle meningeal artery and vein
where does blood accumulate in an extradural haemorrhage?
between blood and bone
how does an extradural haemorrhage present as?
lucid interval pattern - increasing severity of headache + confusion followed by hemiparesis with brisk reflects + up going planar
what happens when bleeding continues in an extra dural haemorrhage?
ipsilateral pupil dilates
coma
bilateral limb weakness
what does a CT show in a extradural haemorrhage?
clot more round shaped bc tough dural attachments to the skull keep it more localised
how is an extradural haemorrhage treated?
stabilise + transfer urgently to neurosurgery unit
