Intercranial haemorrhage Flashcards
What are the 4 main types of intercranial haemorrhage?
Intracerebral haemorrhage
Subarachnoid haemorrhage
Subdural haematoma
Epidural (Extradural) haematoma
What is intercerebrayl haemorrhage?
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
What are the 2 aetiological classes of intracerebral haemorrhage?
Primary
Secondary
What are some causes of primary intracerebral haemorrhage?
Hypertension (Microaneurysm rupture and degeneration of small arteries)
Cerebral amyloid angiopathy
What are some secondary causes of intracerebral haemorrhage?
- Arteriovenous malformations
- Cavernomas
- Aneurysms
- Dural venous thrombosis
- Coagulopathies
What are the 3 locational classes of intracerebral haemorrhage?
Supratentorial (Cortical, lobar)
Infratentorial (Cerebellar, brainstem)
Intraventricular
What are some focal symptoms of intracerebral haemorrhage?
- Paresis
- Dysphasia
- Numbness
- Seizure
- Visual symptoms
- Dyscoordination
What are some global symptoms of intracerebral haemorrhage?
- Headache
- Nausea and vomiting
- Reduced GCS
- Pupils
- Raised ICP
How would a rupture aneurysm causing intracerebral haemorrhage present?
Sudden onset headache
Photophobia
Neck stiffness
How would an arteriovenous malformation (AVM) or cavernoma causing intracerebral haemorrhage present?
Seizure
How would a venous sinus thrombosis causing intracerebral haemorrhage present?
Headache, visual disturbance
How would infection causing intracerebral haemorrhage present?
Temperature, neck stiffness, photophobia, known infective focus
How would a tumour causing intracerebral haemorrhage present?
Seizure, deficit, high ICP features (early morning headache)
What investigations are required in intracerebral haemorrhage?
- 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
What is the ABC bundle of intracerebral haemorrhage management?
A - Anticoagulant reversal
B - Blood pressure management
C - Care pathways
How is warfarin reversed?
Prothrombin complex concentrate (Quicker)
IV Vitamin K (Slower)
How are rivaroxiban and apixaban reversed?
Adaxenet