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Neurology > Intercranial haemorrhage > Flashcards

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
Q

How will subarachnoid haemorrhage show on head CT?

A

Irregular shaped bleed

26
Q

What is shown?

A

Subarachnoid haemorrhage

27
Q

What are the treatment options for subarachnoid haemorrhage?

A
  • Bed rest and supportive measures
  • Control hypertension
  • Nimodipine (a CCB) reduces mortality
28
Q

What is a subdural haematoma?

A

Accumulation of blood in the subdural space following rupture of a vein

29
Q

What is the usual cause of subdural haemorrhage?

A

Usually due to trauma causing damage to one of thebridging veins

30
Q

How does subdural haemorrhage present?

A
  • Symptoms delayed from initial trauma
  • Headache
  • Drowsiness
  • Confusion
  • Focal deficits (Hemiparesis or sensory loss)
  • Possible epilepsy, stupor or coma
31
Q

What investigations are required in subdural haematoma?

A
  • Urgent CT brain - classically shows acrescentof 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
Q

What is shown?

A

Subdural haematoma

33
Q

How is subdural haematoma managed?

A
  • Close neurosurgical monitoring
  • Even large collections can resolve spontaneously without drainage
34
Q

What is an epidural (Extradural) haemorrhage?

A

Collection of blood between the skull and the dura mater

35
Q

What is the typical cause of epidural haemorrhage?

A

Typically follows a linear skull vault fracture tearing a branch of the middle meningeal artery

36
Q

How will epidural haemorrhage present?

A
  • 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
Q

What will CT scanning show in epidural haemorrhage?

A

Lens shapedlesion (biconvex)

38
Q

What is shown?

A

Epidural haemorrhage

39
Q

What is the management option for epidural haemorrhage?

A

Urgent neurosurgery

40
Q

What are the 3 scoring categories of the Glasgow coma scale (GCS)?

A

Eyes
Verbal
Motor

41
Q

What are the 4 points of Eyes in the GCS?

A

Open spontaneously ⇒ 4

Open to speech ⇒ 3

Open to pain ⇒ 2

No opening ⇒ 1

42
Q

What are the 5 points of verbal in the GCS?

A

Orientated ⇒ 5

Confused ⇒ 4

Words ⇒ 3

Sounds ⇒ 2

None ⇒ 1

43
Q

What are the 6 points of motor in the GCS?

A

Obeys ⇒ 6

Localises ⇒ 5

Normal flexion ⇒ 4

Abnormal flexion/flexion withdrawal ⇒ 3

Extension ⇒ 2

None ⇒ 1

Neurology (28 decks)

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