Intracranial bleed Flashcards
Risk factors for Intracerebral bleed?
- head injury
- aneurysm
- ischaemic stroke –> can progress to haemorrhage
- HT
- brain tumour
- anticoagulants ie warfarin
Presentation?
- sudden onset headache
- any sudden onset neurological symptoms
- seizures
- weakness
- reduced consciousness
- vomiting
how do you test for reduced consciousness?
GCS
- <8 = coma
Outline the GCS
At what GCS score should you consider securing the airway?
Eyes
- 4= Spontaneous
- 3= Speech
- 2= Pain
- 1= None
Verbal
- 5=Orientated
- 4=Confused
- 3=Inappropriate words
- 2=Incomprehensible sounds
- 1=None
Motor
- 6= Obeys commands
- 5= Localises to pain
- 4= Withdraws from pain
- 3= Flexion from pain
- 2= Extension from pain
- 1= None
8/15 or below
Subdural Haemorrhage
cause?
mainly due to rupture of the bridging veins in between dura and arachnoid mater
Subdural Haemorrhage
findings on CT?
crescent shape, not limited by cranial sutures
Subdural Haemorrhage
Aetiology?
- Acute - due to severe brain injury
- Chronic- mild injury often in elderly, alcoholics
- have more atrophy in their brain and therefore vessels more prone to rupturing
- because brain is atrophied, there is considerable room for heamatoma to expand before they cause symptoms
Subdural Haemorrhage
Rx
timely surgical evacuation
-this prevents the pathophysiological cycle which otherwise leads to ischaemia and neuronal death
what happens as intracranial pressure rises?
cerebral perfusion pressures and cerebral blood flow may fall –> ischaemic injury occurs
therefore very important to maintain CPP
how do you calculate cerebral perfusion pressure?
MAP-ICP= CPP
Extradural haemorrhage
Cause
Mainly due to rupture of middle meningeal artery, secondary to trauma (may be due to fractured temporal bone)
Extradural haemorrhage
Findings on CT?
bi-convex shape limited by the cranial sutures
Extradural haemorrhage
Presentation?
Usually following traumatic head injury, will present with ongoing headache
Period of improving neurological symptoms & consciousness, followed by a quick decline over hours. This is due to the haematoma becoming large enough to compress intracranial structures
Extradural haemorrhage
Rx?
immediate surgical decompression
What is an Intracerebral bleed?
Aetiology?
bleeding into the brain tissue
May be caused by….
- spontaneous
- ruptured aneurysm
- bleeding into an ischaemic infarct
- brain tumour
What is SAH
bleeding into Subarachnoid space, where CSF is located
Aetiology of SAH
mainly due to rupture of cerebral aneurysm
Prognosis of SAH
associated with high morbidity and mortality
Presentation of SAH
- thunderclap headache
- like been hit in the back of the head with a bat
- neck stiffness
- photophobia
- any other neurological symptoms
- weakness, seizures, loss of consciousness, vision/speech changes
Risk factors for SAH (& therefore for aneurysm)
- FH
- HT
- smoking
- excessive alcohol consumption
- cocaine use
Epidemiology of SAH
- black people
- females
- 45-70y/o
What is SAH associated with?
- cocaine use
- sickle cell anaemia
- connective tissue disorders ie Marfan’s
- neurofibromatosis
Ix for SAH
- CT scan - 1st line
- hyperattenuation in subarachnoid space
- could be normal
- Lumbar Puncture if CT scan negative
- raised red cell count
- xanthochromia - yellow tinge to CSF due to billirubin
- Angiography (CT or MRI) once SAH confirmed
- to locate source of bleed
Mx of SAH
- transfer to specialist neurosurgical unit
- if reduced consciousness –> intubate and ventilate
- surgical treatment
- coiling- endovascular repair
- clipping - involves cranial surgery and putting a clip onto the aneurysm to seal it
- Nimodipine - to prevent vasospasm
- common complication of SAH causing ischaemia
- Anti-epileptics - to treat seizures
- LP/ shunt - treat hydrocephalus
