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Neurology- Clinical > Intracerebral Haemorrhage > Flashcards

Intracerebral Haemorrhage Flashcards

1
Q

In a subarachnoid haemorrhage there is bleeding into where? What structures are found here that can disrupted by this pathology?

A

Subarachnoid space - arteries that supply the brain, and the BBB

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2
Q

Where is the subarachnoid space found?

A

In between the arachnoid and pia mater

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3
Q

In subarachnoid haemorrhage, a pool of blood forms under the arachnoid mater. What effect does this have?

A

Causes increased ICP and prevents blood from flowing into the brain

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4
Q

A subarachnoid haemorrhage can occur without an underlying cause, or it can occur as a result of what 3 things?

A

Trauma, aneurysm, AVM

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5
Q

Why is trauma likely to cause a subarachnoid haemorrhage?

A

Arteries in the subarachnoid space are unsupported and can easily rupture

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6
Q

What is the most common underlying cause predisposing to a SAH?

A

Berry aneurysm

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7
Q

What are some diseases which can predispose to developing a Berry aneurysm?

A

PCKD, Marfan’s

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8
Q

A Berry aneurysm can rupture if there is what?

A

Raised ICP

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9
Q

How can an AVM lead to a SAH?

A

Abnormally high pressure in veins leads to rupture

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10
Q

Why does SAH cause vasospasm?

A

It is an attempt to increase BP to increase cerebral blood flow (since SAH blocks the flow of blood to downstream tissues)

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11
Q

Haemorrhaging blood in SAH can irritate the meninges, what is the clinical outcome of this?

A

It leads to inflammation and scarring which obstructs the outflow of CSF and causes hydrocephalus

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12
Q

What is the most common presenting feature of a SAH?

A

Thunderclap headache (often described as the worst ever headache)

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13
Q

Apart from headache, what are some other presenting features of SAH?

A

Neck stiffness, vomiting, vision changes, confusion/decreased conscious level/collapse, focal neurological deficit

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14
Q

What may be seen on fundoscopy of a patient with SAH?

A

Retinal or vitreous haemorrhage

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15
Q

What are some differentials of a presentation of SAH?

A

Migraine, benign coital cephalgia, exercise induced cephalgia

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16
Q

What are the main red flags for SAH?

A

‘Worst ever headache’, neck stiffness and onset with exertion

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17
Q

What are the 3 main investigations for SAH?

A

CT brain, LP, cerebral angiography

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18
Q

When may a brain CT not pick up a SAH?

A

If its been greater than 3 days since the onset

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19
Q

When is it safe to perform an LP on a patient with suspected SAH?

A

If the patient is alert, has no focal neurological deficits and no papilloedema / after a normal CT scan

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20
Q

What are two results of an LP which are positive for SAH?

A

Red (fresh blood) or yellow (xanthochromia, bilirubin breakdown product, older blood)

21
Q

If a CSF sample comes out yellow, apart from xanthochromia what is another reason for this?

A

Traumatic tap - when the needle hits an epidural vein on entering

22
Q

What is the gold standard investigation for SAH?

A

Cerebral angiography

23
Q

What may cause an aneurysm to be missed on cerebral angiography?

A

Vasospasm

24
Q

What techniques are used to increase the sensitivity of cerebral angiography?

A

CT and MR angiography

25
Q

What is the medical management of a suspected SAH?

A

Bedrest, analgesia, anti-emetic, IV fluids, Ca++ blocker

26
Q

What are the first investigations of a suspected SAH?

A

CT brain and LP if appropriate

27
Q

Once the diagnosis of SAH has been made, what is the management?

A

Referral to neurosurgeons for emergency surgery

28
Q

What are the 5 main complications of SAH?

A

Rebleeding, delayed ischaemic deficit, hydrocephalus, hyponatraemia, seizures

29
Q

When is the risk of rebleeding after a SAH highest? What factors may predispose someone to this?

A

In the first two weeks following SAH, increased risk if elderly or hypertensive

30
Q

How may a delayed ischaemic deficit following SAH present?

A

Altered conscious level or a focal neurological deficit

31
Q

How can a delayed ischaemic deficit be prevented following SAH?

A

Nimodipine and high fluid intake

32
Q

How may hydrocephalus following SAH present?

A

Increasing headache or altered conscious level

33
Q

How can hydrocephalus following SAH be treated?

A

Draining CSF by LP or using a shunt

34
Q

Why does hyponatraemia following SAH occur?

A

SIADH

35
Q

How is hyponatraemia following SAH treated?

A

Do not fluid restrict, supplement Na+ intake and give fludrocortisone to decrease risk of ischaemia

36
Q

Where is the bleeding in an intracerebral haemorrhage?

A

Into the brain parenchyma

37
Q

50% of intracerebral haemorrhages are due to what? / 30% are due to what?

A

Hypertension / aneurysm or AVM

38
Q

What are the 2 main reasons that hypertension causes intracerebral haemorrhage?

A
  1. Causes atherosclerosis which makes the vessels more likely to rupture 2. Causes the formation of microaneurysm
39
Q

An intracerebral haemorrhage where is most likely to be caused by hypertension?

A

Basal ganglia

40
Q

What is haemorrhagic conversion?

A

When bleeding occurs into dead tissue which occurs when there is an intracerebral haemorrhage secondary to an ichaemic stroke

41
Q

Raised ICP occurs following an intracerebral haemorrhage, what can this cause?

A

Brain herniation

42
Q

How may an intracerebral haemorrhage present?

A

Headache, focal neurological deficit, decreased conscious level

43
Q

Any suspected intracerebral haemorrhage should be investigated with what?

A

CT brain and angiography

44
Q

What investigation is needed urgently is there is decreased conscious level in someone who you suspect has an intracerebral haemorrhage?

A

CT brain

45
Q

Why is angiography used to investigate intracerebral haemorrhage?

A

To identify any underlying vascular abnormality

46
Q

How can an intracerebral haemorrhage be treated surgically?

A

Surgical evaluation of the haematoma +/- treatment of the underlying cause

47
Q

What are some medical treatments that can be used to treat intracerebral haemorrhage?

A

Anti-hypertensives, carbonic anhydrase inhibitors

48
Q

When does an intraventricular haemorrhage occur?

A

When a SAH or intracerebral haemorrhage bleed into the ventricles

Neurology- Clinical (31 decks)

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