Intercranial Haemorrhage Flashcards
What is usually the cause of a Subarachnoid haemorrhage?
Berry aneurysm (Circle of Wilis)
How does a Subarachnoid Haemorrhage present?
Sudden severe headache Collapse Vomiting Neck pain Photophobia
What are differentials for sudden onset headache?
Subarachnoid haemorrhage
Migraine
Benign coital cephalgia
What are signs of a Subarachnoid Haemorrhage?
Neck stiffness Photophobia Decreased conscious level Focal neurology deficit (dysphasia, hemiparesis, 3rd nerve palsy Retinal/Vitreous haemorrhage
When may a brain CT be negative?
> 3 days post ictus
When is a lumbar puncture safe to perform?
In alert patient with no focal neurological deficit and no papiloedema after normal CT
Where is a cerebral angiography performed?
Via femoral artery using Seldinger technique
What may cause cerebral angigrophy to miss an aneurysm?
Vasospasm
What are possible complications of a Subarachnoid Haemorrhage?
Re-bleeding Delayed ischaemic deficit Hydrocephalus Hyponatraemia Seizures
When does delayed ischaemia occur?
Days 3-12
What are signs of delayed ischaemia?
Altered conscious level
Vasospasm
What are treatments for delayed ischaemia?
Nimodipine
High fluid intake (Triple H therapy)
What is hydrocephalus?
Increased intercranial CSF pressure
How dos hydrocephalus present?
Increasing headache
Altered conscious level
Often transient (not lasting)
What is the treatment for hydrocephalus?
CSF drainage
LP, EVD, shunt
What is a treatment fo hyponatraemia?
Fludrocortisone
What is an Intracerebral Haemorrhage?
Bleed into the brain parenchyma
What can cause an Intracerebral haemorrhage?
Hypertension
Aneurysm
Arteriovenous malformation
What are Charcot-Bouchard aneurysms?
Microaneurysms arising in small perforating arteries
A form of hypertensive Intracerebral haemorrhage
Basal Ganglia haematoma
How does an Intracerebral Haemorrhage present?
Headache
Focal neurological deficit
Decreased conscious level
How do you investigate an Intracerebral Haemorrhage?
CT scan if urgent decrease in conscious level
Angiography if suspicion of underlying vascular anomaly
How do you treat an Intracerebral Haemorrhage?
Surgical evacuation of haematoma +/- treatment of underlying abnormality
What is a good prognosis of an Intracerebral Haemorrhage?
If small superficial clot and good neurological status
What is a bad prognosis of an Intracerebral haemorrhage?
If large basal ganglia or thalamic clot with major focal deficit or deep coma
What is an Intraventricular Haemorrhage?
Occurs with rupture of subarachnoid or intracerebral bleed into a ventricle
What are treatments of Arteriovenous Malformations?
Surgery Endovascular embolisation Stereotactic radiotherapy Conservative Weigh risk vs benefit
Describe Arteriovanous malformations
Usually intraparenchymal Possibly congenital Seizures Haemorrhages Headache Steal syndrome
