Haemorrhagic stroke Flashcards
What % of stokes are haemorrhagic?
10-20%
Order of intracranial bleeds
Extradural
Dural
Subdural
Arachnoid
Subarachnoid
Pia
Intracerebral
Shape of extradural haemorrhage?
Lemon (cranial sutures)
Shape of subdural haemorrhage?
Banana
GCS- 3 scores measured?
Eyes
Motor
Verbal
GCS- eyes scores
spontaneous- 4
speech-3
pain-2
none-1
GCS- verbal response scores
Orientated- 5
Confused conversation-4
Inappropriate words-3
Incomprehensible sounds-2
None-1
GCS- motor response scores
Obeys commands= 6
Localises pain=5
Withdraws from pain=4
Flexion= 3
Extension= 2
None=1
Cause of extradural?
Rupture of middle meningeal artery in temporal-parietal region (associated with fracture of temporal bone)
Cause of subdural?
Rupture of bridging veins
Cause of subarachnoid?
Ruptured cerebral aneurysm on circle of willis
Hypertension
Cause of intracerebral?
Spontaneous
Bleeding into an ischaemic infarct or tumour
Ruptured aneurysm
Extradural typical patient
Rugby lad
Blow to head
LOC then improved neuro sx then rapid decline over a few hours as haematoma gets big enough to compress intracranial contents
Subdural typical patient
Elderly or alcoholic (brain atrophy so vessels more likely to rupture)
Subarachnoid typical patient
Weightlifter, strenuous sex
Associated with anaemia and sickle cell anaemia
How does an intracerebral haemorrhage present?
bleeding into brain tissue so similar to an ischaemic stroke
Can be anywhere in the brain: cerebella, lobar, basal ganglia
Management
Immediate head CT
Check FBC and clotting
Correct hypertension but avoid hypotension
Consider surgical intervention
Presentation of SAH?
Thunderclap headache
Neck stiffness
Photophobia
Vision changes
Speech changes and weakness
Seizures
LOC
Risk factors for SAH?
Hypertension
Alcohol
Cocaine
Smoking
SAH associated with?
Sickle cell anaemia
Polycystic kidney disease
Connective tissue disorders
Neurofibromatosis
What does a haemorrhagic stroke show up like on a head CT?
Hyperattenuation= white
CT of a SAH?
White star shape- blood fills cisterns
Other investigation for SAH?
LP–> shows xanthochromia (yellow CSF caused by bilirubin) and raised red cell count
Angiography to locate source of bleeding
Management for SAH?
Surgery- clipping and coiling of blood vessels
Nimodipine- CCB to prevent vasospasm (stops ischaemia)
LP or a shunt to treat hydrocephalus
