Intra cranial haemorrhage Flashcards
3 Classifictions of spontaneuous intracranial hameorrhage
Sub Arachnoid
Intracerebral
Intraventricular
What are the underlying cause of subarachnoid haemorrhage
USUALLY berry aneurysm
Can be AVM or no underlying cause
SAH presentation
Sudden onset severe headache
Collapse
Vomiting
Neck pain
Photophobia
Signs in SAH
Neck stiffness Photophobia Decreased concious level Focal neuro deficit Retinal or vitreous haemorrhage
When is lumbar puncture indicated?
In alert patient with no focal neuro deficit or papilloedema
or
after normal CT
What is xanthochromia?
The yellow appearance of CSF on LP caused by bilirubin in the CSF, which can point towards a SAH.
What is the gold standard investigation of SAH?
Cerebral angiography +/- CT or MRI
Note may occasionally miss aneurysm due to vasospasm
Complications of SAH
Re bleeding (-->death) Delayed ischaemic deficit Hydrocephalus Hyponatraemia Seizures
Treatment of rebleeding
Endovascular techniques (GOLD STANDARD)
Surgical clipping for difficult cases
Which drug should be used to prevent the effects of delayed ischaemia following SAH
Nimodipine
Treatment of Hydrocephalus
CSF drainage in the form of LP, External ventricular drainage or shunt
Management of hyponatraemia
Do not fluid restrict
Supplement sodium intake
Fludrocortisone
Causes of intracerebral haemorrhage
50 % Hypertension
30% due to aneurysm or AVM
Presentation of ICH
Headache
Focal neuro deficit
Decreased conscious level
Pathophysiology of Hypertensice ICH
Charcot bouchard microaneurysms arising on small perforating arteries
