Intercranial Haemorrhage

Question 1

What is usually the cause of a Subarachnoid haemorrhage?

Answer 1

Berry aneurysm (Circle of Wilis)

Question 2

How does a Subarachnoid Haemorrhage present?

Answer 2

Sudden severe headache
Collapse
Vomiting
Neck pain
Photophobia

Question 3

What are differentials for sudden onset headache?

Answer 3

Subarachnoid haemorrhage
Migraine
Benign coital cephalgia

Question 4

What are signs of a Subarachnoid Haemorrhage?

Answer 4

Neck stiffness
Photophobia
Decreased conscious level
Focal neurology deficit (dysphasia, hemiparesis, 3rd nerve palsy
Retinal/Vitreous haemorrhage

Question 5

When may a brain CT be negative?

Answer 5

> 3 days post ictus

Question 6

When is a lumbar puncture safe to perform?

Answer 6

In alert patient with no focal neurological deficit and no papiloedema after normal CT

Question 7

Where is a cerebral angiography performed?

Answer 7

Via femoral artery using Seldinger technique

Question 8

What may cause cerebral angigrophy to miss an aneurysm?

Answer 8

Vasospasm

Question 9

What are possible complications of a Subarachnoid Haemorrhage?

Answer 9

Re-bleeding
Delayed ischaemic deficit
Hydrocephalus
Hyponatraemia
Seizures

Question 10

When does delayed ischaemia occur?

Answer 10

Days 3-12

Question 11

What are signs of delayed ischaemia?

Answer 11

Altered conscious level

Vasospasm

Question 12

What are treatments for delayed ischaemia?

Answer 12

Nimodipine

High fluid intake (Triple H therapy)

Question 13

What is hydrocephalus?

Answer 13

Increased intercranial CSF pressure

Question 14

How dos hydrocephalus present?

Answer 14

Increasing headache
Altered conscious level
Often transient (not lasting)

Question 15

What is the treatment for hydrocephalus?

Answer 15

CSF drainage

LP, EVD, shunt

Question 16

What is a treatment fo hyponatraemia?

Answer 16

Fludrocortisone

Question 17

What is an Intracerebral Haemorrhage?

Answer 17

Bleed into the brain parenchyma

Question 18

What can cause an Intracerebral haemorrhage?

Answer 18

Hypertension
Aneurysm
Arteriovenous malformation

Question 19

What are Charcot-Bouchard aneurysms?

Answer 19

Microaneurysms arising in small perforating arteries
A form of hypertensive Intracerebral haemorrhage
Basal Ganglia haematoma

Question 20

How does an Intracerebral Haemorrhage present?

Answer 20

Headache
Focal neurological deficit
Decreased conscious level

Question 21

How do you investigate an Intracerebral Haemorrhage?

Answer 21

CT scan if urgent decrease in conscious level

Angiography if suspicion of underlying vascular anomaly

Question 22

How do you treat an Intracerebral Haemorrhage?

Answer 22

Surgical evacuation of haematoma +/- treatment of underlying abnormality

Question 23

What is a good prognosis of an Intracerebral Haemorrhage?

Answer 23

If small superficial clot and good neurological status

Question 24

What is a bad prognosis of an Intracerebral haemorrhage?

Answer 24

If large basal ganglia or thalamic clot with major focal deficit or deep coma

Question 25

What is an Intraventricular Haemorrhage?

Answer 25

Occurs with rupture of subarachnoid or intracerebral bleed into a ventricle

Question 26

What are treatments of Arteriovenous Malformations?

Answer 26

Surgery
Endovascular embolisation
Stereotactic radiotherapy
Conservative
Weigh risk vs benefit

Question 27

Describe Arteriovanous malformations

Answer 27

Usually intraparenchymal
Possibly congenital
Seizures
Haemorrhages
Headache
Steal syndrome