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Intercranial haemorrhage Flashcards

1
Q

What are the 4 main types of intercranial haemorrhage?

A

Intracerebral haemorrhage
Subarachnoid haemorrhage
Subdural haematoma
Epidural (Extradural) haematoma

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2
Q

What is intercerebrayl haemorrhage?

A

A devastating condition whereby a hematoma is formed within the brain parenchyma with or without blood extension into the ventricle, making up around 10% of strokes

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3
Q

What are the 2 aetiological classes of intracerebral haemorrhage?

A

Primary
Secondary

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4
Q

What are some causes of primary intracerebral haemorrhage?

A

Hypertension (Microaneurysm rupture and degeneration of small arteries)

Cerebral amyloid angiopathy

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5
Q

What are some secondary causes of intracerebral haemorrhage?

A
  • Arteriovenous malformations
  • Cavernomas
  • Aneurysms
  • Dural venous thrombosis
  • Coagulopathies
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6
Q

What are the 3 locational classes of intracerebral haemorrhage?

A

Supratentorial (Cortical, lobar)
Infratentorial (Cerebellar, brainstem)
Intraventricular

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7
Q

What are some focal symptoms of intracerebral haemorrhage?

A
  • Paresis
  • Dysphasia
  • Numbness
  • Seizure
  • Visual symptoms
  • Dyscoordination
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8
Q

What are some global symptoms of intracerebral haemorrhage?

A
  • Headache
  • Nausea and vomiting
  • Reduced GCS
  • Pupils
  • Raised ICP
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9
Q

How would a rupture aneurysm causing intracerebral haemorrhage present?

A

Sudden onset headache
Photophobia
Neck stiffness

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10
Q

How would an arteriovenous malformation (AVM) or cavernoma causing intracerebral haemorrhage present?

A

Seizure

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11
Q

How would a venous sinus thrombosis causing intracerebral haemorrhage present?

A

Headache, visual disturbance

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12
Q

How would infection causing intracerebral haemorrhage present?

A

Temperature, neck stiffness, photophobia, known infective focus

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13
Q

How would a tumour causing intracerebral haemorrhage present?

A

Seizure, deficit, high ICP features (early morning headache)

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14
Q

What investigations are required in intracerebral haemorrhage?

A
  • Imaging - CT brain, CTA, DSA, MRI
  • A combination of GCS and NIHSS (National institute of health stroke scale) are used as GCS may not give a full reading
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15
Q

What is the ABC bundle of intracerebral haemorrhage management?

A

A - Anticoagulant reversal
B - Blood pressure management
C - Care pathways

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16
Q

How is warfarin reversed?

A

Prothrombin complex concentrate (Quicker)
IV Vitamin K (Slower)

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17
Q

How are rivaroxiban and apixaban reversed?

A

Adaxenet

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18
Q

How is dabigatran reversed?

A

Idarizumab

19
Q

What is the target blood pressure for BP management in intracerebral haemorrhage?

A

130-140 systolic

20
Q

Who should be referred for immediate neurosurgical intervention in intracerebral haemorrhage?

A
  • Modified Rankin scale < 3
  • GCS < 9
  • Posterial fossa ICH
  • Haematoma volume > 30ml
21
Q

What is a subarachnoid haemorrhage?

A

Spontaneous arterial bleeding into the subarachnoid space; accounts for 5% of strokes

22
Q

What are some causes of subarachnoid haemorrhage?

A
  • Saccular (Berry) aneurysms
  • Arteriovenous malformation
  • Rare assocations include bleeding disorders, tumours, Marfans or Ehlers-Danlos syndromes
23
Q

How does subarachnoid haemorrhage present?

A
  • Sudden, very severe headache, often occipital (thunderclap)
  • Headache is usually followed by vomiting and often by coma and death (Survivors may remain comatose or drowsy for hours or days after)
24
Q

What are some signs of subarachnoid haemorrhage?

A
  • neck stiffness
  • Positive Kernig’s sign (like in meningitis)
  • Papilloedema is sometimes present
25
How will subarachnoid haemorrhage show on head CT?
Irregular shaped bleed
26
What is shown?
Subarachnoid haemorrhage
27
What are the treatment options for subarachnoid haemorrhage?
- Bed rest and supportive measures - Control hypertension - Nimodipine (a CCB) reduces mortality
28
What is a subdural haematoma?
Accumulation of blood in the subdural space following rupture of a vein
29
What is the usual cause of subdural haemorrhage?
Usually due to trauma causing damage to one of the bridging veins
30
How does subdural haemorrhage present?
- Symptoms delayed from initial trauma - Headache - Drowsiness - Confusion - Focal deficits (Hemiparesis or sensory loss) - Possible epilepsy, stupor or coma
31
What investigations are required in subdural haematoma?
- Urgent CT brain - classically shows a crescent of blood around the brain tissue, and midline shift - If absent, and still suspicious, do LP to confirm - will be blood in CSF - MRI more sensitive for small haematomas
32
What is shown?
Subdural haematoma
33
How is subdural haematoma managed?
- Close neurosurgical monitoring - Even large collections can resolve spontaneously without drainage
34
What is an epidural (Extradural) haemorrhage?
Collection of blood between the skull and the dura mater
35
What is the typical cause of epidural haemorrhage?
Typically follows a linear skull vault fracture tearing a branch of the middle meningeal artery
36
How will epidural haemorrhage present?
- Head injury with brief duration of unconsciousness followed by improvement - Then stuporose with: - Ipsilateral dilated pupil - Contralateral hemiparesis - Rapid transtentorial coning - Followed by: - Bilateral fixed, dilated pupils - Tetraplegia - Respiratory arrest
37
What will CT scanning show in epidural haemorrhage?
Lens shaped lesion (biconvex)
38
What is shown?
Epidural haemorrhage
39
What is the management option for epidural haemorrhage?
Urgent neurosurgery
40
What are the 3 scoring categories of the Glasgow coma scale (GCS)?
Eyes Verbal Motor
41
What are the 4 points of Eyes in the GCS?
Open spontaneously ⇒ 4 Open to speech ⇒ 3 Open to pain ⇒ 2 No opening ⇒ 1
42
What are the 5 points of verbal in the GCS?
Orientated ⇒ 5 Confused ⇒ 4 Words ⇒ 3 Sounds ⇒ 2 None ⇒ 1
43
What are the 6 points of motor in the GCS?
Obeys ⇒ 6 Localises ⇒ 5 Normal flexion ⇒ 4 Abnormal flexion/flexion withdrawal ⇒ 3 Extension ⇒ 2 None ⇒ 1
44

Neurology (28 decks)

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