Intracerebral and Intracranial Bleeds Flashcards
Where is an extra dural haemorrhage?
Between dura and bone
What is the commonest cause of extra-dural haemorrhage?
Skull fracture at the pterion
Which artery is most commonly damaged in extra-dural haemorrhage?
MCA
Describe the classic presentation of an extra-dural haemorrhage
Fall, transient loss of consciousness ICP increase symptoms Low level consciousness Ipsilateral dilated pupil Hemiparesis
How is an extra-dural haemorrhage investigated?
CT - hyperdense, biconvex bleed limited to suture lines
How is an extradural haemorrhage managed?
Immediate evacuation
What is given to a patient with extra-dural haemorrhage whilst waiting for surgery?
Mannitol and hyperventilation
Where is the bleed in a subdural haematoma?
Between dura and arachnoid
What structure is damaged (mostly) in subdural haematoma?
Bridging veins
What is the common presentation of a subdural haematoma?
Elderly alcoholic patient presents after a fall
Unconscious
What drug therapy is associated with a risk of subdural haematoma?
Warfarin
A subdural haematoma that presents after 2 days is classified as….
Acute
How does an acute subdural look on CT?
Hyperdense
A subdural haematoma that presents after 7 days is classified as….
Subacute
How does an acute subdural haemorrhage look on CT?
Isodense
A subdural haematoma that presents after 22 days is classified as….
Chronic
What shape is a subdural haematoma on CT?
Crescent shaped, crosses suture lines
Give 4 risk factors or chronic subdural haematoma
Alcohol abuse
Anticoag use
Abnormal coag
Falls
How is a subdural haemorrhage managed?
Evacuate if >10mm or >5mm but causes midline shift
What is the pathophysiology of a chronic subdural haemorrhage?
Blood from subdural haemorrhage broken down to produce a “motor-oil like” fluid which does not clot
It attracts water
Volume of haematoma/fluid collection then increased
How does a chronic subdural haematoma present?
Features of raised ICP without neuro deficit
What does a CT scan on subdural haematoma show?
Hypodense, crescent shaped mass over the hemisphere
Midline shift
What is a subarachnoid haemorrhage?
Bleed into the subarachnoid space
What is the most common cause of a subarachnoid haemorrhage?
Berry aneurysm
How does a subarachnoid haemorrhage present?
Sudden onset severe headache coming on during a period of exertion
Features of meningitis
How is a subarachnoid haemorrhage investigated?
CT showing hyperdense SA space
How is a subarachnoid haemorrhage managed?
Endovascular clip or coil
Give CCBs to prevent vasospasm
Analgesia
